Individual provider Active NPI

Michael R Gonzales

  • Social Worker
  • Fresno, CA
National Provider Identifier
1467980367
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
117647 Issued in CA
Practice address
2560 W Shaw LN Ste 104
Fresno, CA 93711-2777
Phone
(559) 443-4800
NPI assigned
May 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Social Worker 104100000X 86192 CA
Clinical Social Worker 1041C0700X 86192 CA
Social Worker 104100000X 117647 CA Primary

Addresses

Primary practice location

2560 W Shaw LN Ste 104
Fresno, CA 93711-2777

Mailing address

2560 W Shaw LN Ste 104
Fresno, CA 93711-2777
Phone (559) 443-4820

Other practice location 1

2020 High St Ste E
Selma, CA 93662-3518
Phone (559) 443-4800

Other practice location 2

4939 E Yale Ave
Fresno, CA 93727-1523
Phone (559) 691-0706

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
117647CAMDSocial Worker
86192CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fresno County Superintendent of Schools CurrentSince Apr 1, 2024 Accepting new patients
Fresno County Superintendent of Schools CurrentSince Sep 17, 2023 Accepting new patients
Poverello House PastSince Aug 1, 2021 Accepting new patients
Fresno County Superintendent of Schools PastSince May 17, 2020 Accepting new patients

Locations

4939 E Yale Ave
Fresno, CA 93727
Phone (559) 443-4820

2560 W Shaw Ln
Ste 104
Fresno, CA 93711
Phone (559) 431-1086

2440 Tulare St
Ste 200
Fresno, CA 93721
Phone (559) 265-3089

2020 High St
Ste E
Selma, CA 93662
Phone (559) 443-8000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1467980367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 W SHAW LN STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937112777",
            "telephone_number": "559-443-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 W SHAW LN STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937112777",
            "telephone_number": "559-443-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 High St Ste E",
            "address_purpose": "LOCATION",
            "city": "Selma",
            "state": "CA",
            "postal_code": "936623518",
            "country_code": "US",
            "telephone_number": "559-443-4800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4939 E Yale Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937271523",
            "country_code": "US",
            "telephone_number": "559-691-0706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-23",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "86192",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "86192",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "117647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.