Provider Demographics
NPI:1578692422
Name:GONZALEZ, DIANE L (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 UNIONPORT RD APT ME
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7806
Mailing Address - Country:US
Mailing Address - Phone:718-657-7100
Mailing Address - Fax:718-657-7137
Practice Address - Street 1:8956 162ND ST FL 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5072
Practice Address - Country:US
Practice Address - Phone:718-657-7100
Practice Address - Fax:718-657-7137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health