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General NPI Number Information
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NPI Number | 1720360068
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Entity Type | Individual
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Provider Name | MAGNOLIA BEATRIZ GONZALEZ HEATON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 120 DARTMOUTH DR SE UNIT D
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City | ALBUQUERQUE
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State | NM
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Zip | 87106
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Country | US
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Telephone | 505-333-9042
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Fax | 505-796-5475
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Provider Business Mailing Address
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Address Line | 120 DARTMOUTH DR SE APT D
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2261
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Country | US
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Telephone | 505-333-9042
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Fax | 505-796-5475
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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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 | C-10610
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License Number State | NM
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