Basic Information
| Provider Information | |||||||||
| NPI: | 1295009504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ-DESPAIN | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 481 MAIN ST | ||||||||
| Address2: | 401 | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108016324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143552440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1285 ROCKAWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112362330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182573195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2012 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 006520 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.