Provider Demographics
NPI:1457072381
Name:A WHOLE NEW YOU, LICENSED CLINICAL SOCIAL WORKER, INC
Entity Type:Organization
Organization Name:A WHOLE NEW YOU, LICENSED CLINICAL SOCIAL WORKER, INC
Other - Org Name:LYNN GONZALEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-267-2579
Mailing Address - Street 1:170 E COLLEGE ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-7008
Mailing Address - Country:US
Mailing Address - Phone:626-267-2579
Mailing Address - Fax:
Practice Address - Street 1:150 N GRAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1757
Practice Address - Country:US
Practice Address - Phone:626-267-2579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty