Provider Demographics
NPI:1518095322
Name:GONZALEZ, L CAROLINA (LICSW)
Entity Type:Individual
Prefix:
First Name:L CAROLINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BEACON ST
Mailing Address - Street 2:SUITE 720
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-3704
Mailing Address - Country:US
Mailing Address - Phone:617-224-8729
Mailing Address - Fax:
Practice Address - Street 1:1601 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1951
Practice Address - Country:US
Practice Address - Phone:617-425-2060
Practice Address - Fax:617-424-8725
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical