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General NPI Number Information
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NPI Number | 1275196479
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Entity Type | Individual
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Provider Name | MICHELLE YVONNE GONZALEZ LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 480 HOPE ST FL 1
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City | PROVIDENCE
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State | RI
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Zip | 02906-1631
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Country | US
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Telephone | 401-601-8995
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Fax |
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Provider Business Mailing Address
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Address Line | 332 AQUEDUCT RD
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City | CRANSTON
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State | RI
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Zip | 02910-5203
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Country | US
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Telephone |
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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 | 224627
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW03286
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12743-C
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License Number State | NV
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