Provider Demographics
NPI:1306251392
Name:GONZALEZ, ANDREA PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PATRICIA
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 1:1424 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3421
Mailing Address - Country:US
Mailing Address - Phone:347-340-9355
Mailing Address - Fax:
Practice Address - Street 1:1424 30TH ST STE G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3421
Practice Address - Country:US
Practice Address - Phone:347-340-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615571041C0700X
NY73 0767601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical