Healthcare Provider Details

I. General information

NPI: 1518002757
Provider Name (Legal Business Name): GENEVIEVE GONZALEZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/19/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17A OLD TOPSFIELD RD
BOXFORD MA
01921-2666
US

IV. Provider business mailing address

PO BOX 68
BOXFORD MA
01921-0068
US

V. Phone/Fax

Practice location:
  • Phone: 781-724-2600
  • Fax:
Mailing address:
  • Phone: 781-469-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111743
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: