Provider Demographics
NPI:1720360068
Name:HEATON, MAGNOLIA BEATRIZ GONZALEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:BEATRIZ GONZALEZ
Last Name:HEATON
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 1:2849 NE 1ST DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3031
Mailing Address - Country:US
Mailing Address - Phone:505-333-9042
Mailing Address - Fax:505-796-5475
Practice Address - Street 1:120 DARTMOUTH DR SE
Practice Address - Street 2:UNIT D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-333-9042
Practice Address - Fax:505-796-5475
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12425851Medicaid