Provider Demographics
NPI:1629713078
Name:GONZALEZ, LUIS (LMHC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 TRATMAN AVE APT C20
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3462
Mailing Address - Country:US
Mailing Address - Phone:347-878-8118
Mailing Address - Fax:
Practice Address - Street 1:2514 TRATMAN AVE APT C20
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3462
Practice Address - Country:US
Practice Address - Phone:347-878-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health