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NPI Code Detail

MEDICARE: KATHLEEN GONZALEZ LMSW

MEDICARE: KATHLEEN GONZALEZ LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker16119SC

General Provider Information

NPI Number : 1154104230
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN GONZALEZ LMSW
Provider Business Mailing Address
First Line : 2100 SUMMERSWEET PL
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29681-2830
Country : US
Telephone Number : 843-666-7721
Fax Number :
Provider Business Practice Location Address
First Line : 325 S CHURCH ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29306-5231
Country : US
Telephone Number : 864-582-5431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2023
Last Update Date : 08/14/2023

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Directions to “ KATHLEEN GONZALEZ LMSW” Practice Location

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