MEDICARE: JUDITH 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	ISW21522	FL

General Provider Information

NPI Number	:	1871443168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH GONZALEZ

Provider Business Mailing Address
First Line	:	11224 RABUN GAP DR
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-4223
Country	:	US
Telephone Number	:	239-645-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	12220 TOWNE LAKE DR STE 5
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8021
Country	:	US
Telephone Number	:	239-645-3866
Fax Number	:

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

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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