MEDICARE: GERDA GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	114060	NY
2	1041C0700X	Clinical Social Worker	098597	NY

General Provider Information

NPI Number	:	1275159188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERDA GONZALEZ

Provider Business Mailing Address
First Line	:	3119 77TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1824
Country	:	US
Telephone Number	:	917-379-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3119 77TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1824
Country	:	US
Telephone Number	:	917-379-1066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/12/2025

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Directions to “ GERDA GONZALEZ ” Practice Location

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