Provider Demographics
NPI:1437345139
Name:GONZALEZ, JACQUELINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
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 1:9380 SUNSET DR STE B120
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5456
Mailing Address - Country:US
Mailing Address - Phone:305-274-3172
Mailing Address - Fax:305-274-0841
Practice Address - Street 1:9380 SUNSET DR STE B120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5456
Practice Address - Country:US
Practice Address - Phone:305-274-3172
Practice Address - Fax:305-274-0841
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW98061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical