Provider Demographics
NPI:1700436268
Name:GONZALEZ, NOELIA (CWCM)
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CWCM
Other - Prefix:
Other - First Name:NOELIA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CWCM
Mailing Address - Street 1:8719 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6111
Mailing Address - Country:US
Mailing Address - Phone:267-679-9922
Mailing Address - Fax:
Practice Address - Street 1:8719 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-6111
Practice Address - Country:US
Practice Address - Phone:267-679-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty