Provider Demographics
NPI:1477236768
Name:GONZALEZ, AMANDA GABRIELLE (BA, MS)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GABRIELLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DARIAN CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3015
Mailing Address - Country:US
Mailing Address - Phone:914-523-2416
Mailing Address - Fax:
Practice Address - Street 1:2005 PALMER AVE # 606
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2437
Practice Address - Country:US
Practice Address - Phone:855-400-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor