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General NPI Number Information
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NPI Number | 1578370920
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Entity Type | Individual
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Provider Name | MARCOS GONZALES LSW
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Gender | Male
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 2249 W IOWA ST APT 2F
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City | CHICAGO
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State | IL
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Zip | 60622-5221
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Country | US
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Telephone | 818-900-3965
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST UNIT 1078
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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Country | US
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Telephone | 818-900-3965
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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 | 150.113922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.113922
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License Number State | IL
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