MEDICARE: MR. STEVEN GONZALEZ L.C.S.W.

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	1123	CO

General Provider Information

NPI Number	:	1821141615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN GONZALEZ L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 116
Second Line	:
City	:	WELLINGTON
State	:	CO
Zip	:	80549-0116
Country	:	US
Telephone Number	:	970-568-3477
Fax Number	:	970-568-3304

Provider Business Practice Location Address
First Line	:	3725 CLEVELAND AVENUE
Second Line	:	OFFICES G&H
City	:	WELLINGTON
State	:	CO
Zip	:	80549
Country	:	US
Telephone Number	:	970-568-3477
Fax Number	:	970-568-3304

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	03/30/2010

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