Provider Demographics
NPI:1053453480
Name:GONZALES, EDWARD A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 SOUTH DOWNING ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210
Mailing Address - Country:US
Mailing Address - Phone:303-778-5774
Mailing Address - Fax:305-778-2436
Practice Address - Street 1:2465 SOUTH DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210
Practice Address - Country:US
Practice Address - Phone:303-778-5774
Practice Address - Fax:305-778-2436
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991518104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker