Provider Demographics
NPI:1144651506
Name:GONZALEZ, SALOME BRANAS (BCBA)
Entity type:Individual
Prefix:
First Name:SALOME
Middle Name:BRANAS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 GRAND CONCOURSE
Mailing Address - Street 2:1D-E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2611
Mailing Address - Country:US
Mailing Address - Phone:347-577-5844
Mailing Address - Fax:347-577-5845
Practice Address - Street 1:2940 GRAND CONCOURSE
Practice Address - Street 2:1D-E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2611
Practice Address - Country:US
Practice Address - Phone:347-577-5844
Practice Address - Fax:347-577-5845
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11312904103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst