Provider Demographics
NPI:1962977975
Name:GONZALEZ, LYANNE KARINA
Entity type:Individual
Prefix:
First Name:LYANNE
Middle Name:KARINA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 UNION AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2067
Mailing Address - Country:US
Mailing Address - Phone:347-377-1387
Mailing Address - Fax:
Practice Address - Street 1:160 UNION AVE FL 2
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2067
Practice Address - Country:US
Practice Address - Phone:347-377-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst