Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 085075-1 | NY |
NPI | 1003290958 |
---|---|
Provider Name | Mrs. Karina Melissa Gonzalez |
First Address | Bronx, NY 10458-1151 |
Second Address | New York, NY 10027-4990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2015 |
Last Update Date | 09/07/2015 |