Provider Demographics
NPI:1427477074
Name:GONZALEZ, JOHNDAVID (LCSW)
Entity type:Individual
Prefix:
First Name:JOHNDAVID
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE ST STE 22
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1551
Mailing Address - Country:US
Mailing Address - Phone:914-343-4143
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE ST STE 22
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1551
Practice Address - Country:US
Practice Address - Phone:914-343-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty