Provider Demographics
NPI:1568692085
Name:GONZALEZ, LOURDES MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:MARIA
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 1:7402 N 56TH ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7733
Mailing Address - Country:US
Mailing Address - Phone:813-374-2237
Mailing Address - Fax:813-374-2241
Practice Address - Street 1:7402 N 56TH ST
Practice Address - Street 2:SUITE 801
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7733
Practice Address - Country:US
Practice Address - Phone:813-374-2237
Practice Address - Fax:813-374-2241
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical