Basic Information
| Provider Information | |||||||||
| NPI: | 1003290958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | KARINA | ||||||||
| MiddleName: | MELISSA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 E 206TH ST APT 2A | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104581151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475420053 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2090 ADAM CLAYTON POWELL JR BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125536708 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2015 | ||||||||
| LastUpdateDate: | 07/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 085075-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.