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General NPI Number Information
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NPI Number | 1861849044
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Entity Type | Individual
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Provider Name | MAYA ROSA GONZALEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 549TH HOSPITAL CENTER/BDAACH UNIT #15245
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City | APO
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State | AP
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Zip | 96271-0000
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Country | US
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Telephone | 315-737-1857
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 444 BOX 2072
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City | APO
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State | AP
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Zip | 96297-0021
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Country | US
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Telephone | 315-737-5669
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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-18248
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License Number State | AZ
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