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General NPI Number Information
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NPI Number | 1750104568
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Entity Type | Individual
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Provider Name | ISAIAH XAVIER GONZALEZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 330 N 16TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85007-2443
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Country | US
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Telephone | 480-267-0320
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Fax |
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Provider Business Mailing Address
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Address Line | 3955 W READE AVE
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City | PHOENIX
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State | AZ
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Zip | 85019-2895
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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 | LCSW-22462
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License Number State | AZ
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