Provider Demographics
NPI:1639645195
Name:GONZALES, MICHAEL (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1509
Mailing Address - Country:US
Mailing Address - Phone:732-546-2453
Mailing Address - Fax:
Practice Address - Street 1:65 SOUTH ST FL 2
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2348
Practice Address - Country:US
Practice Address - Phone:732-546-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00285800101YA0400X
NJ44SC060953001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00285800OtherLCADC