Provider Demographics
NPI:1013323864
Name:GONZALES, VALERIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:GONZALES
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:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-1268
Mailing Address - Country:US
Mailing Address - Phone:505-259-9407
Mailing Address - Fax:
Practice Address - Street 1:16 CRESENCIANO RD
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059
Practice Address - Country:US
Practice Address - Phone:505-259-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-08680104100000X
NMM-092421041C0700X
NMSWB-2023-12551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker