Provider Demographics
NPI:1023513413
Name:GONZALEZ, GERALDO LUIS (LMFT 125933)
Entity type:Individual
Prefix:
First Name:GERALDO
Middle Name:LUIS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMFT 125933
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STANYAN ST # 3N
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1019
Mailing Address - Country:US
Mailing Address - Phone:415-750-5580
Mailing Address - Fax:415-750-4912
Practice Address - Street 1:450 STANYAN ST # 3N
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1019
Practice Address - Country:US
Practice Address - Phone:415-750-5580
Practice Address - Fax:415-750-4912
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist