Provider Demographics
NPI:1275922288
Name:GONZALEZ, TERRI (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:BODNOVITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:440 MARION ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2015
Mailing Address - Country:US
Mailing Address - Phone:734-904-9350
Mailing Address - Fax:
Practice Address - Street 1:440 MARION ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2015
Practice Address - Country:US
Practice Address - Phone:734-904-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010879301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical