Provider Demographics
NPI:1962976431
Name:NUNEZ, GUSTAVO R (LMSW)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:R
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:R
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:3708 91ST ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7962
Mailing Address - Country:US
Mailing Address - Phone:718-779-2263
Mailing Address - Fax:
Practice Address - Street 1:3708 91ST ST STE 3A
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7962
Practice Address - Country:US
Practice Address - Phone:718-779-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105894104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker