Healthcare Provider Details

I. General information

NPI: 1326371782
Provider Name (Legal Business Name): JAMIELYNN GONZALES DSW, LCSW, FSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 EUBANK BLVD NE STE B1
ALBUQUERQUE NM
87111-3583
US

IV. Provider business mailing address

3736 EUBANK BLVD NE STE B1
ALBUQUERQUE NM
87111-3583
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-1578
  • Fax: 888-506-2110
Mailing address:
  • Phone: 505-382-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07502
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-06869
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-07502
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: