MEDICARE: JENIFER LYNN GONZALEZ MSW, LCSW, LCAS, CCS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	23440	NC
2	1041C0700X	Clinical Social Worker	P011430	NC
3	1041C0700X	Clinical Social Worker	C012247	NC

General Provider Information

NPI Number	:	1962994152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER LYNN GONZALEZ MSW, LCSW, LCAS, CCS

Provider Business Mailing Address
First Line	:	606 PINETREE DR
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-4430
Country	:	US
Telephone Number	:	252-288-4045
Fax Number	:	252-351-0335

Provider Business Practice Location Address
First Line	:	606 PINETREE DR
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-4430
Country	:	US
Telephone Number	:	252-288-4045
Fax Number	:	252-351-0335

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	09/07/2024

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