| Doctor Name: | MRS. TARA-MARIE GONZALEZ |
| NPI Number: | 1023090917 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSWR |
| License Number: | R051143-1 |
| Business Practice Address: | 1234 W Broadway Suite #4 Hewlett, NY - 115571929 |
| Business Phone Number: | 5164269672 |
| Business Fax Number: | |
| Mailing Address: | 93 Baisley Ave, EAST ROCKAWAY |
| State: | NY |
| Postal Code: | 115181820 |
| Phone Number: | 5165936513 |
| Fax Number: | |
| NPI Enumeration Date: | 11/16/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R051143-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |