Gustavo Gonzalez, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I 3441 Issued in NM

Practice address

1337 Gusdorf Road, Suite M
Taos, NM 87571-6671

Phone

(575) 758-4297

Fax

(575) 751-7237

NPI assigned

Jul 30, 2009

Last updated

Dec 20, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292803200000",
    "number": "1144451766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 GUSDORF RD STE M",
            "address_2": "PO BOX 2238",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875717200",
            "telephone_number": "575-758-4297",
            "fax_number": "575-751-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 GUSDORF ROAD, SUITE M",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716671",
            "telephone_number": "575-758-4297",
            "fax_number": "575-751-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "GUSTAVO",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-30",
        "last_updated": "2010-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "I 3441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T 8238",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla A Gonzales, PT DPT
• Marisa Gonzales
• Shannen D Gonzales, MOT, OTR/L
• Tanya Renee Gonzales, PHARM. D.
• Frank Gonzalez, ACT
• Maria Gonzalez, BMS
• Oralia Gonzalez
• Lauren M Good, M.D.
• Robert Gordon
• Sarkis Seperghan Gorial

• Clinical Social Worker in Taos, NM
• Providers in Taos, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.