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NPI Code Detail

MEDICARE: JOSE GONZALEZ LCSW

MEDICARE: JOSE 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social WorkerCSW.09927109CO
31041C0700XClinical Social Worker163569AK

General Provider Information

NPI Number : 1871044743
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE GONZALEZ LCSW
Provider Business Mailing Address
First Line : 39610 RANCH PLACE
Second Line :
City : KENAI
State : AK
Zip : 99611
Country : US
Telephone Number : 907-600-1684
Fax Number : 907-308-5882
Provider Business Practice Location Address
First Line : 502 LAKE ST
Second Line :
City : KENAI
State : AK
Zip : 99611-6937
Country : US
Telephone Number : 907-600-1684
Fax Number : 907-308-5882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2016
Last Update Date : 10/30/2024

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