MEDICARE: MS. VERONICA GONZALEZ SMITH 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	LCS 24386	CA

General Provider Information

NPI Number	:	1528148806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VERONICA GONZALEZ SMITH LCSW

Provider Business Mailing Address
First Line	:	12598 CENTRAL AVE STE 205
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-3530
Country	:	US
Telephone Number	:	951-634-1594
Fax Number	:	909-591-5094

Provider Business Practice Location Address
First Line	:	12598 CENTRAL AVE STE 205
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-3530
Country	:	US
Telephone Number	:	951-634-1594
Fax Number	:	909-591-5094

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/03/2020

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