Provider Demographics
NPI:1417013624
Name:GONZALEZ, TERESITA E (MSS)
Entity Type:Individual
Prefix:MS
First Name:TERESITA
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E. CHELSEA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2112
Mailing Address - Country:US
Mailing Address - Phone:610-355-0691
Mailing Address - Fax:
Practice Address - Street 1:185 EAST CHELSEA CIR
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2112
Practice Address - Country:US
Practice Address - Phone:610-355-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA SW002130-E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker