MEDICARE: JOSE B GONZALEZ LCSW

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	101YM0800X	Mental Health Counselor	62626	CA
2	225400000X	Rehabilitation Practitioner
3	1041C0700X	Clinical Social Worker	LCSW80920	CA

General Provider Information

NPI Number	:	1689844847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE B GONZALEZ LCSW

Provider Business Mailing Address
First Line	:	3576 ARLINGTON AVE STE 100
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3907
Country	:	US
Telephone Number	:	951-374-1555
Fax Number	:	951-394-7426

Provider Business Practice Location Address
First Line	:	3576 ARLINGTON AVE STE 100
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3907
Country	:	US
Telephone Number	:	951-374-1555
Fax Number	:	951-394-7426

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	06/26/2019

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