Provider Demographics
NPI:1952320491
Name:GONZALEZ, MIGDALIA I (LCSW)
Entity Type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4065
Mailing Address - Country:US
Mailing Address - Phone:718-287-1240
Mailing Address - Fax:718-287-0337
Practice Address - Street 1:370 LENOX RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2206
Practice Address - Country:US
Practice Address - Phone:718-287-1240
Practice Address - Fax:718-287-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0706711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical