Provider Demographics
NPI:1508159955
Name:GONZALEZ, LUIS ANGEL (LCSW)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:GONZALEZ
Suffix:
Gender:M
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:PO BOX 4342
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0434
Mailing Address - Country:US
Mailing Address - Phone:707-341-6356
Mailing Address - Fax:
Practice Address - Street 1:1447 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2805
Practice Address - Country:US
Practice Address - Phone:707-341-6356
Practice Address - Fax:707-425-9880
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical