Active NPI
Nicole Lynn Gonzalez, LCSW
- Mental Health Counselor
- Brooklyn, NY
National Provider Identifier
1033650171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 012892-01
- Practice address
- 34 Plaza Street East P109
Vanderbilt Plaza
Brooklyn, NY 11238-3980 - Phone
- (646) 490-1930
- Fax
- (646) 809-8580
- NPI assigned
- Mar 8, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 090136 | NY | |
| Mental Health Counselor | 101YM0800X | 012892-01 | NY | Primary |
Addresses
Primary practice location
34 Plaza Street East P109
Vanderbilt Plaza
Brooklyn, NY 11238-3980
Mailing address
34 Plaza Street East P109
Vanderbilt Plaza
Brooklyn, NY 11238-3980
Phone (646) 490-1930
Other practice location 1
36 Plaza Street East
Apt 1A, Plaza Wellness
Brooklyn, NY 11238
Phone (347) 927-2530
Other practice location 2
148 Park Pl
Brooklyn, NY 11217-3303
Phone (718) 398-1962
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012892-01 | NY | MD | Mental Health Counselor |
| 090136 | NY | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roots Branches Therapy LCSW PLLC | Mental Health | Current | Accepting new patients |
| New Pathways Counseling Center | Clinical | Past | Accepting new patients |
Locations
34 Plaza St E
Ste P109
Brooklyn, NY 11238
Phone (646) 490-1930
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682035200000",
"number": "1033650171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 PLAZA STREET EAST P109",
"address_2": "VANDERBILT PLAZA",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112383980",
"telephone_number": "646-490-1930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 PLAZA STREET EAST P109",
"address_2": "VANDERBILT PLAZA",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112383980",
"telephone_number": "646-490-1930",
"fax_number": "646-809-8580"
}
],
"practiceLocations": [
{
"address_1": "36 Plaza Street East",
"address_2": "Apt 1A, Plaza Wellness",
"address_purpose": "LOCATION",
"city": "Brooklyn",
"state": "NY",
"postal_code": "11238",
"country_code": "US",
"telephone_number": "347-927-2530",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "148 Park Pl",
"address_purpose": "LOCATION",
"city": "Brooklyn",
"state": "NY",
"postal_code": "112173303",
"country_code": "US",
"telephone_number": "718-398-1962",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GONZALEZ",
"first_name": "NICOLE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-08",
"last_updated": "2023-04-21",
"certification_date": "2023-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "090136",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "012892-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.