Provider Demographics
NPI:1285186205
Name:GONZALEZ, NOELIS
Entity Type:Individual
Prefix:
First Name:NOELIS
Middle Name:
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 1:1294 GRANT AVE
Mailing Address - Street 2:APT. 3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1318
Mailing Address - Country:US
Mailing Address - Phone:917-444-6817
Mailing Address - Fax:
Practice Address - Street 1:1294 GRANT AVE
Practice Address - Street 2:APT. 3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1318
Practice Address - Country:US
Practice Address - Phone:917-444-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician