Provider Demographics
NPI:1346923307
Name:JEANPAULO A. GONZALEZ, LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type:Organization
Organization Name:JEANPAULO A. GONZALEZ, LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEANPAULO
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-264-1388
Mailing Address - Street 1:101 E REDLANDS BLVD STE 234A
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4775
Mailing Address - Country:US
Mailing Address - Phone:909-264-1388
Mailing Address - Fax:
Practice Address - Street 1:101 E REDLANDS BLVD STE 234A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4775
Practice Address - Country:US
Practice Address - Phone:909-264-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health