Provider Demographics
NPI:1376129569
Name:GOSSNER, JOSEPH EMMETT JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EMMETT
Last Name:GOSSNER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:
Practice Address - Street 1:1300 W OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5678
Practice Address - Country:US
Practice Address - Phone:805-737-1169
Practice Address - Fax:805-737-1772
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA999781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical