Healthcare Provider Details

I. General information

NPI: 1598801201
Provider Name (Legal Business Name): CAMILO GONZALEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24660 AMADOR ST APT 209
HAYWARD CA
94544-2156
US

IV. Provider business mailing address

24660 AMADOR ST APT 209
HAYWARD CA
94544-2156
US

V. Phone/Fax

Practice location:
  • Phone: 650-771-4408
  • Fax:
Mailing address:
  • Phone: 650-244-0305
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number091920
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number091920
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number091920
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120884
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number120884
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: