Provider Demographics
NPI:1881410470
Name:GONZALEZ, MIGUEL (MA)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 138TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4154
Mailing Address - Country:US
Mailing Address - Phone:347-858-2336
Mailing Address - Fax:
Practice Address - Street 1:8115 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1118
Practice Address - Country:US
Practice Address - Phone:718-380-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities