Individual
JOSE M FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
1776 CLAY AVE, BRONX, NY 10457-7299
(718) 960-7599
Mailing address
311 E 175TH ST, BRONX, NY 10457-5848
(718) 960-7568
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20930
NY
Other
Enumeration date
02/09/2022
Last updated
02/09/2022
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