MEDICARE: ELISE A 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	ISW01889	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ISW01889	OTHER	RI	LICSW

General Provider Information

NPI Number	:	1871793521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE A GONZALEZ

Provider Business Mailing Address
First Line	:	4 SMITHFIELD RD APT 5
Second Line	:
City	:	N PROVIDENCE
State	:	RI
Zip	:	02904-5368
Country	:	US
Telephone Number	:	401-595-4755
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SMITHFIELD RD APT 5
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-5368
Country	:	US
Telephone Number	:	401-595-4755
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	03/26/2026

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