Healthcare Provider Details

I. General information

NPI: 1790374809
Provider Name (Legal Business Name): MARITZA GONZALEZ SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARITZA GONZALEZ AGOSTO

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 MONTGOMERY RD STE 250
CINCINNATI OH
45249-2395
US

IV. Provider business mailing address

11085 MONTGOMERY RD STE 250
CINCINNATI OH
45249-2395
US

V. Phone/Fax

Practice location:
  • Phone: 513-547-2861
  • Fax:
Mailing address:
  • Phone: 513-547-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2309326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: