Provider Demographics
NPI:1700213907
Name:GONZALEZ, LIZETTE M (MSED CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LIZETTE
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 PELHAM PKWY N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4905
Mailing Address - Country:US
Mailing Address - Phone:718-519-7000
Mailing Address - Fax:
Practice Address - Street 1:999 PELHAM PKWY N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4905
Practice Address - Country:US
Practice Address - Phone:718-519-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007549-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist