Provider Demographics
NPI:1609014554
Name:GONZALEZ, ANDREA E
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1502
Mailing Address - Country:US
Mailing Address - Phone:201-873-8611
Mailing Address - Fax:
Practice Address - Street 1:545 HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2417
Practice Address - Country:US
Practice Address - Phone:201-873-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2019-07-10
Deactivation Date:2011-08-09
Deactivation Code:
Reactivation Date:2019-03-20
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-21638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst