Provider Demographics
NPI:1932207941
Name:GONZALEZ, JUSTINE M (LMSW CSW)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMSW CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36975 UTICA RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-226-3440
Mailing Address - Fax:586-226-3672
Practice Address - Street 1:45445 MOUND
Practice Address - Street 2:STE 109
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317
Practice Address - Country:US
Practice Address - Phone:586-254-5660
Practice Address - Fax:586-254-0622
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI68010206721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM10270039Medicare ID - Type Unspecified