Healthcare Provider Details

I. General information

NPI: 1336234038
Provider Name (Legal Business Name): BENJAMIN O GONZALEZ MSW, ACSW, LSWAIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENJAMIN OCEGUEDA MSW, ACSW, LSWAIC

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST FL 7
GARDENA CA
90248-4220
US

IV. Provider business mailing address

879 W 190TH ST FL 7
GARDENA CA
90248-4220
US

V. Phone/Fax

Practice location:
  • Phone: 310-707-2801
  • Fax: 310-669-9501
Mailing address:
  • Phone: 310-217-7312
  • Fax: 310-496-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124625
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61567484
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: