Provider Demographics
NPI:1073175238
Name:GONZALEZ, LEO JR (LMHC, NCC)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BEDFORD AVE.
Mailing Address - Street 2:STE A PMB 1025
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211
Mailing Address - Country:US
Mailing Address - Phone:212-287-7979
Mailing Address - Fax:
Practice Address - Street 1:223 BEDFORD AVE.
Practice Address - Street 2:STE A PMB 1025
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211
Practice Address - Country:US
Practice Address - Phone:212-287-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty