Provider Demographics
NPI:1043020845
Name:GONZALEZ, NATALIA (LAC)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 EASTON AVE APT J
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1639
Mailing Address - Country:US
Mailing Address - Phone:732-609-0809
Mailing Address - Fax:
Practice Address - Street 1:500 CRAIG RD STE 102
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8748
Practice Address - Country:US
Practice Address - Phone:848-444-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00841200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health