Active NPI
Dereck Hugh Gonzalez, CSW
- Clinical Social Worker
- Provo, UT
National Provider Identifier
1689248205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12883692-3502
- Practice address
- 34 S 300 E
Provo, UT 84606-3201 - Phone
- (801) 850-9147
- Fax
- (435) 578-0700
- NPI assigned
- May 18, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 12883692-3502 | UT | Primary |
Addresses
Primary practice location
34 S 300 E
Provo, UT 84606-3201
Mailing address
34 S 300 E
Provo, UT 84606-3201
Phone (801) 850-9147
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
| License | State | Type | Specialty |
|---|---|---|---|
| 12883692-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666224000000",
"number": "1689248205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 S 300 E",
"city": "PROVO",
"state": "UT",
"postal_code": "846063201",
"telephone_number": "801-850-9147",
"fax_number": "435-578-0700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 S 300 E",
"city": "PROVO",
"state": "UT",
"postal_code": "846063201",
"telephone_number": "801-850-9147",
"fax_number": "435-578-0700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "DERECK",
"middle_name": "HUGH",
"name_prefix": "Mr.",
"credential": "CSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-18",
"last_updated": "2022-10-20",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "12883692-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.