Provider Demographics
NPI:1871347807
Name:GONZALEZ, AUSTIN LEE
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LEE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 E 91ST ST APT 1506
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0065
Mailing Address - Country:US
Mailing Address - Phone:850-322-7797
Mailing Address - Fax:
Practice Address - Street 1:113 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4527
Practice Address - Country:US
Practice Address - Phone:917-960-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health