1033519335 NPI number — MS. MELISSA ROSE GONZALES LMSW

Table of content: MS. MELISSA ROSE GONZALES LMSW (NPI 1033519335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033519335 NPI number — MS. MELISSA ROSE GONZALES LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES
Provider First Name:
MELISSA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRINGALI
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033519335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17414 BRADY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48240-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-929-3437
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20600 EUREKA RD STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-5343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-785-7700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2014

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: 1041C0700X , with the licence number:  6801106684 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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