MEDICARE: MADELEINE GONZALEZ LCSW

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
1	1041C0700X	Clinical Social Worker	76090	CA

General Provider Information

NPI Number	:	1164669248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE GONZALEZ LCSW

Provider Business Mailing Address
First Line	:	9625 MAPLEWOOD ST
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-3048
Country	:	US
Telephone Number	:	562-279-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 S LA CIENEGA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-6260
Country	:	US
Telephone Number	:	213-507-1814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	04/15/2022

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