Provider Demographics
NPI:1952512857
Name:GONZALES, MARIA L
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569-0708
Mailing Address - Country:US
Mailing Address - Phone:956-358-0680
Mailing Address - Fax:956-347-3165
Practice Address - Street 1:14644 FARM TO MARKET ROAD 498
Practice Address - Street 2:
Practice Address - City:LYFORD
Practice Address - State:TX
Practice Address - Zip Code:78569
Practice Address - Country:US
Practice Address - Phone:956-347-3165
Practice Address - Fax:956-347-3165
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01539104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker