Provider Demographics
NPI:1104015239
Name:GONZALEZ, ERNESTINE B (LMSW-AP)
Entity Type:Individual
Prefix:MRS
First Name:ERNESTINE
Middle Name:B
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMSW-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3027
Mailing Address - Country:US
Mailing Address - Phone:512-258-0491
Mailing Address - Fax:512-258-2561
Practice Address - Street 1:8805 SPRING LAKE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3027
Practice Address - Country:US
Practice Address - Phone:512-258-0491
Practice Address - Fax:512-258-2561
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker