MEDICARE: MARY GONZALEZ, LICENSED CLINICAL WORKER INC.

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

General Provider Information

NPI Number	:	1588512008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY GONZALEZ, LICENSED CLINICAL WORKER INC.

Provider Business Mailing Address
First Line	:	3861 S BRISTOL ST UNIT 1038
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7426
Country	:	US
Telephone Number	:	909-248-8176
Fax Number	:

Provider Business Practice Location Address
First Line	:	3861 S BRISTOL ST UNIT 1038
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7426
Country	:	US
Telephone Number	:	909-248-8176
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MARY TERE GONZALEZ NAVARRO
Credential	:	LCSW
Telephone Number	:	909-248-8176

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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