Provider Demographics
NPI:1881817120
Name:GONZALEZ, MARIA LEONOR (ACSW LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LEONOR
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ACSW LCSW
Other - Prefix:
Other - First Name:LEONOR
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACSW LCSW
Mailing Address - Street 1:6318 RICHMOND AVE
Mailing Address - Street 2:#2104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214
Mailing Address - Country:US
Mailing Address - Phone:214-714-5524
Mailing Address - Fax:
Practice Address - Street 1:6318 RICHMOND AVE
Practice Address - Street 2:NUMBER 2104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3681
Practice Address - Country:US
Practice Address - Phone:214-370-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R59825Medicare UPIN
TX00318PMedicare ID - Type Unspecified