Provider Demographics
NPI:1265620074
Name:GONZALEZ, SAKIMA (LMSW)
Entity type:Individual
Prefix:
First Name:SAKIMA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ANDERSON AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1845
Mailing Address - Country:US
Mailing Address - Phone:347-605-3518
Mailing Address - Fax:
Practice Address - Street 1:750 TILDEN ST
Practice Address - Street 2:ASTOR CHILD GUIDANCE CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-231-3400
Practice Address - Fax:718-655-3503
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074748-1104100000X
NJ44CS054292001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker