Provider Demographics
NPI:1902945892
Name:GONZALEZ, MARYLOU
Entity Type:Individual
Prefix:MS
First Name:MARYLOU
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NIAGARA STREET
Mailing Address - Street 2:LOWER WEST SIDE COUNSELING
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213
Mailing Address - Country:US
Mailing Address - Phone:716-884-0700
Mailing Address - Fax:716-884-0631
Practice Address - Street 1:951 NIAGARA STREET
Practice Address - Street 2:LOWER WEST SIDE COUNSELING
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213
Practice Address - Country:US
Practice Address - Phone:716-884-0700
Practice Address - Fax:716-884-0631
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor