Healthcare Provider Details

I. General information

NPI: 1629420161
Provider Name (Legal Business Name): JENNIFER GONZALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MCGEE LCSW

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

IV. Provider business mailing address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC-10738
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10738
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: