Healthcare Provider Details

I. General information

NPI: 1326473083
Provider Name (Legal Business Name): BRENDA GONZALEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

701 E 28TH ST
LONG BEACH CA
90806-2759
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-3121
  • Fax: 562-216-6197
Mailing address:
  • Phone: 562-246-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW62947
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW82072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: