Healthcare Provider Details

I. General information

NPI: 1124541263
Provider Name (Legal Business Name): SAMUEL JESUS GONZALEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 S CLAIBORNE AVE STE 537
NEW ORLEANS LA
70125-4142
US

IV. Provider business mailing address

6221 S CLAIBORNE AVE
NEW ORLEANS LA
70125-4142
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16576
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: