Provider Demographics
NPI:1821806209
Name:MARIA G. GONZALEZ, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:MARIA G. GONZALEZ, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPISR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GUADALUPE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:657-200-8440
Mailing Address - Street 1:1950 E CHAPMAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4141
Mailing Address - Country:US
Mailing Address - Phone:657-200-8440
Mailing Address - Fax:
Practice Address - Street 1:1950 E CHAPMAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4141
Practice Address - Country:US
Practice Address - Phone:657-200-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health