Healthcare Provider Details

I. General information

NPI: 1720754955
Provider Name (Legal Business Name): EMILY AIDEE GONZALEZ ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-3506
US

IV. Provider business mailing address

3663 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-3506
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-8490
  • Fax:
Mailing address:
  • Phone: 310-900-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: