Provider Demographics
NPI:1215572367
Name:GONZALEZ, ALEXANDRIA (LMSW, CASAC-ADV)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMSW, CASAC-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5916
Mailing Address - Country:US
Mailing Address - Phone:603-966-8424
Mailing Address - Fax:
Practice Address - Street 1:2 CORACI BLVD STE 15&16
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-315-2320
Practice Address - Fax:631-315-9473
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35312101YA0400X
NY118711104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)