Provider Demographics
NPI:1770848814
Name:GONZALEZ, JORDANIA (MSED)
Entity Type:Individual
Prefix:
First Name:JORDANIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2417
Mailing Address - Country:US
Mailing Address - Phone:917-294-3834
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:917-294-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst