Provider Demographics
NPI:1114536729
Name:GONZALES, AMANDA (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CANDELARIA RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1965
Mailing Address - Country:US
Mailing Address - Phone:505-273-6300
Mailing Address - Fax:505-265-7860
Practice Address - Street 1:3301 CANDELARIA RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1965
Practice Address - Country:US
Practice Address - Phone:505-273-6300
Practice Address - Fax:505-265-7860
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-116161041C0700X
NMM-116661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical