Provider Demographics
NPI:1043890650
Name:GONZALEZ MARTINEZ, JULIO CARLOS (LMHC)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CARLOS
Last Name:GONZALEZ MARTINEZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4700
Mailing Address - Country:US
Mailing Address - Phone:631-809-2286
Mailing Address - Fax:
Practice Address - Street 1:220 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2755
Practice Address - Country:US
Practice Address - Phone:631-809-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health