Provider Demographics
NPI:1679032098
Name:GONZALEZ, SHERRY MARIE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7927 PAINTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2480
Mailing Address - Country:US
Mailing Address - Phone:562-204-6010
Mailing Address - Fax:
Practice Address - Street 1:7927 PAINTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2480
Practice Address - Country:US
Practice Address - Phone:562-204-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128945106H00000X
CA103473106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist