Provider Information for 1265828933
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SHANNA BETH GONZALEZ LMSW
Sex: Female
NPI: 1265828933
Last Updated: 2015-04-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1265828933 | ||||||||
| Enumeration Date | 2015-04-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 939 JOHNSON AVE RONKONKOMA, NY 11779-6066 United States Phone: 631-471-7242 | Fax:631-471-5150 | ||||||||
| Primary Practice Address | 939 JOHNSON AVE RONKONKOMA, NY 11779-6066 United States Phone: 631-471-7242 | Fax:631-471-5150 | ||||||||
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