Provider Demographics
NPI:1225113491
Name:GONZALEZ, MARIE THERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESA
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 1:127 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1039
Mailing Address - Country:US
Mailing Address - Phone:908-203-8122
Mailing Address - Fax:908-203-8123
Practice Address - Street 1:24 DREAHOOK RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3729
Practice Address - Country:US
Practice Address - Phone:908-203-8122
Practice Address - Fax:908-203-8123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053028001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical