Provider Demographics
NPI:1184008468
Name:GONZALEZ, NANETTE MARIA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4109
Mailing Address - Country:US
Mailing Address - Phone:516-406-8912
Mailing Address - Fax:
Practice Address - Street 1:160 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5320
Practice Address - Country:US
Practice Address - Phone:516-406-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18006685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health