Provider Demographics
NPI:1659597797
Name:GONZALES, BENJAMIN-JOHN VI (MA, NCC, LPC, LCADC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN-JOHN
Middle Name:
Last Name:GONZALES
Suffix:VI
Gender:M
Credentials:MA, NCC, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WOODLANE ROAD SUITE 301
Mailing Address - Street 2:
Mailing Address - City:MT. HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4730
Mailing Address - Country:US
Mailing Address - Phone:609-267-1377
Mailing Address - Fax:
Practice Address - Street 1:795 WOODLANE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3832
Practice Address - Country:US
Practice Address - Phone:609-267-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00134200101YA0400X
NJ37PC00330100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)