Provider Demographics
NPI:1033508445
Name:HERNANDEZ-GOLEY, EVA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:HERNANDEZ-GOLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W NYACK RD
Mailing Address - Street 2:STE 43
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2241
Mailing Address - Country:US
Mailing Address - Phone:917-428-6177
Mailing Address - Fax:
Practice Address - Street 1:719 W NYACK RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2240
Practice Address - Country:US
Practice Address - Phone:917-428-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079883-11041C0700X
NY083247-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical