Provider Demographics
NPI:1669926135
Name:LORRAINE GONZALEZ LCSW PLLC
Entity type:Organization
Organization Name:LORRAINE GONZALEZ LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-396-2290
Mailing Address - Street 1:921 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1025
Mailing Address - Country:US
Mailing Address - Phone:917-396-2290
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3606
Practice Address - Country:US
Practice Address - Phone:917-396-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0761671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty