Basic Information
| Provider Information | |||||||||
| NPI: | 1053744102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | LUCIANA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 E 112TH ST | ||||||||
| Address2: | APT 2 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100293078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055359163 | ||||||||
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| Practice Location | |||||||||
| Address1: | 579 COURTLANDT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184852100 | ||||||||
| FaxNumber: | 7184852101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.