Provider Demographics
NPI:1740854959
Name:GONZALEZ MARTINEZ, ANA P
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:P
Last Name:GONZALEZ MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WESSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3206
Mailing Address - Country:US
Mailing Address - Phone:973-563-8378
Mailing Address - Fax:
Practice Address - Street 1:18 MICROLAB RD STE 3
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1640
Practice Address - Country:US
Practice Address - Phone:862-253-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-24-72745103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst