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General NPI Number Information
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NPI Number | 1316287261
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Entity Type | Individual
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Provider Name | LISA ANN GONZALEZ LLMSW
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Gender | Female
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 107 S BROAD ST B-1
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City | ADRIAN
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State | MI
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Zip | 49221-2752
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Country | US
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Telephone | 517-264-8086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8224
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City | ANN ARBOR
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State | MI
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Zip | 48107-8224
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Country | US
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Telephone | 323-377-5608
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801094121
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License Number State | MI
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