MEDICARE: MR. ANTHONY ERIC 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	SW9647	FL

General Provider Information

NPI Number	:	1356604243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY ERIC GONZALEZ LCSW

Provider Business Mailing Address
First Line	:	111 SE 1ST AVE APT 410
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3796
Country	:	US
Telephone Number	:	561-703-2660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 CLARE AVE STE 5
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6219
Country	:	US
Telephone Number	:	561-703-2660
Fax Number	:

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

Provider Enumeration Date	:	06/17/2012
Last Update Date	:	04/30/2020

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