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General NPI Number Information
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NPI Number | 1255678041
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Entity Type | Individual
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Provider Name | SAMANTHA J GONZALEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 190 E MICHIGAN AVE STE A100
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City | BATTLE CREEK
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State | MI
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Zip | 49014-4019
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Country | US
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Telephone | 269-565-3936
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Fax |
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Provider Business Mailing Address
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Address Line | 4465 W MILHAM AVE APT 3
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City | PORTAGE
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State | MI
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Zip | 49024-1708
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Country | US
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Telephone | 231-742-0792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093645
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License Number State | MI
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