MEDICARE: ELVIALUZ GONZALEZ

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	150119221	IL

General Provider Information

NPI Number	:	1720681935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIALUZ GONZALEZ

Provider Business Mailing Address
First Line	:	3637 OAK PARK AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 OAK PARK AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3866
Country	:	US
Telephone Number	:	312-826-4185
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	03/04/2026

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Directions to “ ELVIALUZ GONZALEZ ” Practice Location

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