Provider Demographics
NPI:1609148410
Name:GONZALEZ-SURIEL HERNANDEZ, WANDA I (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:I
Last Name:GONZALEZ-SURIEL HERNANDEZ
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 1:21 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-4052
Mailing Address - Country:US
Mailing Address - Phone:917-609-9879
Mailing Address - Fax:
Practice Address - Street 1:21 ROBERT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-4052
Practice Address - Country:US
Practice Address - Phone:917-609-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077509-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical