Basic Information
| Provider Information | |||||||||
| NPI: | 1538808704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | CASANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6039 FLUSHING AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | MASPETH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113783266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3479694926 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6714 41ST AVE | ||||||||
| Address2: | |||||||||
| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113778128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184584243 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.