MEDICARE: RAQUEL MARIA GONZALEZ L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW0004138	FL

General Provider Information

NPI Number	:	1447468434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL MARIA GONZALEZ L.C.S.W.

Provider Business Mailing Address
First Line	:	6719 WINKLER RD STE 212
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7200
Country	:	US
Telephone Number	:	239-939-3700
Fax Number	:	239-939-3889

Provider Business Practice Location Address
First Line	:	6719 WINKLER RD STE 212
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7200
Country	:	US
Telephone Number	:	239-939-3700
Fax Number	:	239-939-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	01/31/2023

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