Provider Demographics
NPI:1326371782
Name:GONZALES, JAMIELYNN (DSW, LCSW, FSW)
Entity Type:Individual
Prefix:DR
First Name:JAMIELYNN
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DSW, LCSW, FSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 EUBANK BLVD NE STE B1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3583
Mailing Address - Country:US
Mailing Address - Phone:505-382-1578
Mailing Address - Fax:888-506-2110
Practice Address - Street 1:3736 EUBANK BLVD NE STE B1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3583
Practice Address - Country:US
Practice Address - Phone:505-382-1578
Practice Address - Fax:888-506-2110
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06869104100000X
NMC-075021041C0700X
NMI-075021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29283396Medicaid
NM29283396Medicaid