Provider Demographics
NPI:1942434055
Name:GONZALEZ, NORMA IRIS (MSW, LSW CFBT)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:IRIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, LSW CFBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5232
Mailing Address - Country:US
Mailing Address - Phone:717-270-6972
Mailing Address - Fax:717-270-6987
Practice Address - Street 1:618 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5232
Practice Address - Country:US
Practice Address - Phone:717-274-2741
Practice Address - Fax:717-274-5405
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134854104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103619576Medicaid