1245565787 NPI number — MRS. ELIZABETH A. GONZALEZ LBSW

Table of content: MRS. ELIZABETH A. GONZALEZ LBSW (NPI 1245565787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245565787 NPI number — MRS. ELIZABETH A. GONZALEZ LBSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
ELIZABETH
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LBSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LBSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245565787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 N. CAGE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-3187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-283-1889
Provider Business Mailing Address Fax Number:
956-283-7014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 N CAGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-283-1889
Provider Business Practice Location Address Fax Number:
956-283-7014
Provider Enumeration Date:
10/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  27826 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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