Provider Demographics
NPI:1912283706
Name:GONELL, ANNY E (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ANNY
Middle Name:E
Last Name:GONELL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HEMPSTEAD TPKE STE 12A
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5707
Mailing Address - Country:US
Mailing Address - Phone:516-731-0683
Mailing Address - Fax:516-731-0518
Practice Address - Street 1:4250 HEMPSTEAD TPKE STE 12A
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5707
Practice Address - Country:US
Practice Address - Phone:516-731-0683
Practice Address - Fax:516-731-0518
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-074259-R1041C0700X
NY18513281041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool