Provider Demographics
NPI:1134272305
Name:GONZALEZ, BEATRIZ (MSW LISW LCSW)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW LISW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 107
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2942
Mailing Address - Country:US
Mailing Address - Phone:402-212-0027
Mailing Address - Fax:401-300-8169
Practice Address - Street 1:1941 S 42ND ST STE 107
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2942
Practice Address - Country:US
Practice Address - Phone:402-212-0027
Practice Address - Fax:401-300-8169
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3129101YP2500X
IA06813104100000X
NE12191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037658526Medicaid