Active NPI
Maira Fannydia Gonzalez Perez
- Clinical Social Worker
- Hayward, CA
National Provider Identifier
1972029478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 115351
- Practice address
- 24301 Southland Dr Ste 300
Hayward, CA 94545 - Phone
- (510) 300-3500
- Fax
- (877) 992-0038
- NPI assigned
- Aug 16, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | ||
| Clinical Social Worker | 1041C0700X | 115351 | CA | Primary |
Addresses
Primary practice location
24301 Southland Dr Ste 300
Hayward, CA 94545
Mailing address
24301 Southland Dr Ste 300
Hayward, CA 94545-1546
Phone (510) 300-3500
Other practice location 1
26081 Mocine Ave
Hayward, CA 94544-2923
Phone (510) 881-5921
Other practice location 2
26081 Mocine Ave
Hayward, CA 94544-2923
Phone (510) 881-5921
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 |
|---|---|---|---|
| 115351 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685404800000",
"number": "1972029478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24301 SOUTHLAND DR STE 300",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945451546",
"telephone_number": "510-300-3500",
"fax_number": "877-992-0038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24301 SOUTHLAND DR STE 300",
"city": "HAYWARD",
"state": "CA",
"postal_code": "94545",
"telephone_number": "510-300-3500",
"fax_number": "877-992-0038"
}
],
"practiceLocations": [
{
"address_1": "26081 Mocine Ave",
"address_purpose": "LOCATION",
"city": "Hayward",
"state": "CA",
"postal_code": "945442923",
"country_code": "US",
"telephone_number": "510-881-5921",
"fax_number": "510-881-5925",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "26081 Mocine Ave",
"address_purpose": "LOCATION",
"city": "Hayward",
"state": "CA",
"postal_code": "945442923",
"country_code": "US",
"telephone_number": "510-881-5921",
"fax_number": "510-881-5925",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GONZALEZ PEREZ",
"first_name": "MAIRA",
"middle_name": "FANNYDIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-16",
"last_updated": "2023-05-30",
"certification_date": "2023-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "115351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.