Provider Demographics
NPI:1639957012
Name:GONZALEZ, TIMOTHY JAIMES (MSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAIMES
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 BIRNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1104
Mailing Address - Country:US
Mailing Address - Phone:413-733-6624
Mailing Address - Fax:
Practice Address - Street 1:1236 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2955
Practice Address - Country:US
Practice Address - Phone:413-584-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical