Provider Demographics
NPI:1083181010
Name:GONZALEZ-SMITH, JENNIFER M (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:GONZALEZ-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 ASYLUM AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1901
Mailing Address - Country:US
Mailing Address - Phone:860-522-8241
Mailing Address - Fax:
Practice Address - Street 1:10 LONE OAK AVE
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-1519
Practice Address - Country:US
Practice Address - Phone:860-522-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT124991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program