Provider Demographics
NPI:1194522714
Name:GONZALEZ, JAMIE P
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:P
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BOSTON RD APT 6K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-5073
Mailing Address - Country:US
Mailing Address - Phone:347-336-6448
Mailing Address - Fax:
Practice Address - Street 1:124 E 108TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3501
Practice Address - Country:US
Practice Address - Phone:212-828-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical