Provider Demographics
NPI:1700247426
Name:GONZALEZ, KIMBERLY ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:HACKSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:4470 VEGAS VALLEY DRIVE
Mailing Address - Street 2:SPC 173
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1926
Mailing Address - Country:US
Mailing Address - Phone:702-319-1405
Mailing Address - Fax:702-778-7632
Practice Address - Street 1:5800 W. CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-832-7080
Practice Address - Fax:702-258-7849
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6506-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker