Provider Demographics
NPI:1942579388
Name:GONZALEZ, WILFREDO (CASAC)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4738
Mailing Address - Country:US
Mailing Address - Phone:718-306-5146
Mailing Address - Fax:718-306-5165
Practice Address - Street 1:425 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2605
Practice Address - Country:US
Practice Address - Phone:718-306-5125
Practice Address - Fax:718-306-5165
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)