Individual provider Active NPI

Elizabeth Nussbaum-Gonzalez, LSW

  • Counselor
  • Goshen, IN
National Provider Identifier
1932746989
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
330 Lakeview Dr
Goshen, IN 46528-7000
Phone
(574) 533-1234
Fax
(574) 537-2652
NPI assigned
Dec 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

330 Lakeview Dr
Goshen, IN 46528-7000

Mailing address

PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234

Other names 1

  • Elizabeth Nussbaum Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230720000255 IN Practitioner - Clinical Social Worker 9436519642 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oaklawn Psychiatric Center, Inc. CurrentSince Jun 22, 2023 Accepting new patients
Oaklawn Psychiatric Center, Inc. CurrentSince Jun 22, 2023 Accepting new patients

Locations

330 Lakeview Dr
Goshen, IN 46528
Phone (219) 533-1234

Organizations & group practices 2

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": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1932746989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465270809",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LAKEVIEW DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465287000",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSSBAUM-GONZALEZ",
        "first_name": "ELIZABETH",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-09",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "NUSSBAUM",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.