Provider Demographics
NPI:1164280871
Name:GONZALEZ, DORA IDALIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:IDALIA
Last Name:GONZALEZ
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 1:1101 CAMINO LA COSTA
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3930
Mailing Address - Country:US
Mailing Address - Phone:512-478-4939
Mailing Address - Fax:
Practice Address - Street 1:1101 CAMINO LA COSTA
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3930
Practice Address - Country:US
Practice Address - Phone:512-478-4939
Practice Address - Fax:512-708-3184
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical