Provider Demographics
NPI:1770699803
Name:GONZALEZ, CARLOS (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GRISWOLD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06050
Mailing Address - Country:US
Mailing Address - Phone:860-224-5267
Mailing Address - Fax:860-224-5752
Practice Address - Street 1:50 GRISWOLD STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06050
Practice Address - Country:US
Practice Address - Phone:860-224-5267
Practice Address - Fax:860-224-5752
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003786104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003118Medicare ID - Type Unspecified