Healthcare Provider Details

I. General information

NPI: 1689510117
Provider Name (Legal Business Name): NICOLAS GONZALEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 COTTAGE ST
BOSTON MA
02128-2290
US

IV. Provider business mailing address

82 BRISTOW ST
SAUGUS MA
01906-2841
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-8510
  • Fax:
Mailing address:
  • Phone: 617-792-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLCSW228046
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: