Provider Demographics
NPI:1558626648
Name:GONZALEZ, ANNETTE (PYSD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WOODWARD AVE APT 322
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1376
Mailing Address - Country:US
Mailing Address - Phone:516-670-5261
Mailing Address - Fax:
Practice Address - Street 1:55 W 39TH ST RM 305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3830
Practice Address - Country:US
Practice Address - Phone:516-670-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist