Fernando Gonzalez III, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.021105 Issued in IL

Practice address

207 E Ohio St # 271
Chicago, IL 60611-4092

Phone

(708) 351-8212

NPI assigned

Jul 31, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• The Videri Clinic for Emotional Health PLLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1760137558
  NPD Authorized official

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1891273900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 E OHIO ST # 271",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114092",
            "telephone_number": "708-351-8212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E OHIO ST # 271",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114092",
            "telephone_number": "708-351-8212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1840 Oak Ave Ste 320",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602013680",
            "country_code": "US",
            "telephone_number": "847-256-7334 x130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "FERNANDO",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-31",
        "last_updated": "2021-04-01",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021105",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150102999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Gonzalez
• Emma Franco Gonzalez
• Emmanuel Gonzalez, PSYD
• Enrique Gonzalez, PH.D.
• Evert Gonzalez
• Frank Gonzalez, M.D.
• Gabriel Gonzalez, RBT
• Gizelle Gonzalez
• Grisel Gonzalez
• Hanna Christi Gonzalez

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.