Healthcare Provider Details

I. General information

NPI: 1821806209
Provider Name (Legal Business Name): MARIA G. GONZALEZ, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E CHAPMAN AVE STE 3
FULLERTON CA
92831-4141
US

IV. Provider business mailing address

1950 E CHAPMAN AVE STE 3
FULLERTON CA
92831-4141
US

V. Phone/Fax

Practice location:
  • Phone: 657-200-8440
  • Fax:
Mailing address:
  • Phone: 657-200-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA GUADALUPE GONZALEZ
Title or Position: OWNER/THERAPISR
Credential: LCSW
Phone: 657-200-8440