Healthcare Provider Details

I. General information

NPI: 1558194506
Provider Name (Legal Business Name): VANESSA LEON-GONZALEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13727 SW 152ND ST # 1392
MIAMI FL
33177-1106
US

IV. Provider business mailing address

10222 SW 228TH TER
MIAMI FL
33190-1990
US

V. Phone/Fax

Practice location:
  • Phone: 727-916-7144
  • Fax:
Mailing address:
  • Phone: 786-493-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW18003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: