1881817120 NPI number — MARIA LEONOR GONZALEZ ACSW LCSW

Table of content: MARIA LEONOR GONZALEZ ACSW LCSW (NPI 1881817120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881817120 NPI number — MARIA LEONOR GONZALEZ ACSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
MARIA
Provider Middle Name:
LEONOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
LEONOR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ACSW LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881817120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6318 RICHMOND AVE
Provider Second Line Business Mailing Address:
#2104
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-714-5524
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6318 RICHMOND AVE
Provider Second Line Business Practice Location Address:
NUMBER 2104
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75214-3681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-370-9884
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

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:  01213 , 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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