MEDICARE: ABIGAIL ROSE 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
1	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	IC-2699	NV
3	104100000X	Social Worker	12257-M	NV

General Provider Information

NPI Number	:	1477338465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ROSE GONZALEZ LMSW

Provider Business Mailing Address
First Line	:	4530 S DECATUR BLVD STE 201B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 S DECATUR BLVD STE 201B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5239
Country	:	US
Telephone Number	:	702-486-7865
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	12/08/2025

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