Active NPI
Susie Ann Gonsalves, LCSW
- Mental Health Counselor
- Temecula, CA
National Provider Identifier
1295768513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCS18971
- Practice address
- 32605 Highway 79 South
Suite 206
Temecula, CA 92592 - Phone
- (951) 302-6400
- Fax
- (951) 302-6400
- NPI assigned
- Jul 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCS18971 | CA | Primary |
Addresses
Primary practice location
32605 Highway 79 South
Suite 206
Temecula, CA 92592
Mailing address
32605 Highway 79 South
Suite 206
Temecula, CA 92592
Phone (951) 302-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18971 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295768513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32605 HIGHWAY 79 SOUTH",
"address_2": "SUITE 206",
"city": "TEMECULA",
"state": "CA",
"postal_code": "92592",
"telephone_number": "951-302-6400",
"fax_number": "951-302-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32605 HIGHWAY 79 SOUTH",
"address_2": "SUITE 206",
"city": "TEMECULA",
"state": "CA",
"postal_code": "92592",
"telephone_number": "951-302-6400",
"fax_number": "951-302-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONSALVES",
"first_name": "SUSIE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "LCS18971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Temecula, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.