Provider Demographics
NPI:1508320110
Name:ISLAS GONZALEZ, PALOMA (MSW)
Entity Type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:ISLAS GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 3RD AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4073
Mailing Address - Country:US
Mailing Address - Phone:718-520-8000
Mailing Address - Fax:
Practice Address - Street 1:33 W 60TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7905
Practice Address - Country:US
Practice Address - Phone:646-799-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113OtherMBHP
MA1134107113OtherBEACON
MA1134107113OtherNHP
MA12529OtherHNE
MA71756OtherTUFTS
MA042622756OtherCCA
MA1134107113OtherFALLON
MA1134107113Medicaid
MA997303OtherNETWORK HEALTH
MAY10086OtherMEDICARE