Healthcare Provider Details

I. General information

NPI: 1003740275
Provider Name (Legal Business Name): JOSE MIGUEL GONZALEZ RIVERA LMSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S STATE ST #226, ANN ARBOR, MI 48108
ANN ARBOR MI
48108
US

IV. Provider business mailing address

10958 OAK LN APT 6215
VAN BUREN TOWNSHIP MI
48111-4377
US

V. Phone/Fax

Practice location:
  • Phone: 734-789-3313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801121413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: