Provider Demographics
NPI:1942637665
Name:GONZALES, MONDIE (LISW)
Entity Type:Individual
Prefix:
First Name:MONDIE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17637 SHURMER RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6157
Mailing Address - Country:US
Mailing Address - Phone:216-210-4041
Mailing Address - Fax:
Practice Address - Street 1:17637 SHURMER RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6157
Practice Address - Country:US
Practice Address - Phone:216-210-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
I00093771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical