Provider Demographics
NPI:1942622758
Name:GONZALEZ, THOMAS EDWARD (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 ARLINGTON AVE
Mailing Address - Street 2:APT. 19D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1402
Mailing Address - Country:US
Mailing Address - Phone:917-573-1387
Mailing Address - Fax:
Practice Address - Street 1:3265 JOHNSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:917-573-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical