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NPI Code Detail

MEDICARE: MR. BRIAN CHRISTOPHER GONZALES LCSW

MEDICARE:  MR. BRIAN CHRISTOPHER GONZALES  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
11041C0700XClinical Social WorkerCSW09923037CO

General Provider Information

NPI Number : 1831497304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN CHRISTOPHER GONZALES LCSW
Provider Business Mailing Address
First Line : 1175 EMERSON ST APT 302
Second Line :
City : DENVER
State : CO
Zip : 80218-2749
Country : US
Telephone Number : 720-201-0390
Fax Number :
Provider Business Practice Location Address
First Line : 3680 W PRINCETON CIR
Second Line :
City : DENVER
State : CO
Zip : 80236-3109
Country : US
Telephone Number : 720-283-3626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2011
Last Update Date : 10/04/2012

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Directions to “ MR. BRIAN CHRISTOPHER GONZALES LCSW” Practice Location

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