Provider Demographics
NPI:1346016086
Name:GONZALEZ, SOFIA NATALIA (MSED)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:NATALIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15513 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4304
Mailing Address - Country:US
Mailing Address - Phone:954-802-5069
Mailing Address - Fax:
Practice Address - Street 1:401 PARK AVE SOUTH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0000
Practice Address - Country:US
Practice Address - Phone:607-289-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health