Provider Demographics
NPI:1033519335
Name:GONZALES, MELISSA ROSE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ROSE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ROSE
Other - Last Name:TRINGALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17414 BRADY
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2100
Mailing Address - Country:US
Mailing Address - Phone:313-929-3437
Mailing Address - Fax:
Practice Address - Street 1:20600 EUREKA RD STE 800
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5343
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011066841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical