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NPI Code Detail

MEDICARE: MRS. ANDREA LEE GATES-GONZALEZ LCSW

MEDICARE: MRS. ANDREA LEE GATES-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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376683342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANDREA LEE GATES-GONZALEZ LCSW
Provider Business Mailing Address
First Line : 4500 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4823
Country : US
Telephone Number : 772-672-8344
Fax Number :
Provider Business Practice Location Address
First Line : 4500 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4823
Country : US
Telephone Number : 772-467-3097
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 09/21/2021

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