Healthcare Provider Details

I. General information

NPI: 1457590291
Provider Name (Legal Business Name): JANINE GONZALEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 3RD ST SW STE 101
WINTER HAVEN FL
33880-2980
US

IV. Provider business mailing address

150 3RD ST SW STE 101
WINTER HAVEN FL
33880-2980
US

V. Phone/Fax

Practice location:
  • Phone: 863-289-2865
  • Fax:
Mailing address:
  • Phone: 863-289-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18534
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1095
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: