Provider Demographics
NPI:1326128794
Name:GONZALES-RICARD, DIANA MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIA
Last Name:GONZALES-RICARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:MARIA
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 CONKLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-362-9040
Mailing Address - Fax:
Practice Address - Street 1:9 CONKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-362-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068390-11041C0700X
NY0756891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical