Provider Demographics
NPI:1508959891
Name:GONZALEZ, INES VERONICA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:INES
Middle Name:VERONICA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 135TH ST
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2731
Mailing Address - Country:US
Mailing Address - Phone:212-283-9597
Mailing Address - Fax:
Practice Address - Street 1:4 CHATSWORTH AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2946
Practice Address - Country:US
Practice Address - Phone:914-630-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5577594UPD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical