Provider Demographics
NPI:1336234038
Name:GONZALEZ, BENJAMIN O (MSW, ACSW, LSWAIC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:O
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:MSW, ACSW, LSWAIC
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:OCEGUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW, LSWAIC
Mailing Address - Street 1:14112 S KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3018
Mailing Address - Country:US
Mailing Address - Phone:310-217-7312
Mailing Address - Fax:310-496-2757
Practice Address - Street 1:14112 S KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3018
Practice Address - Country:US
Practice Address - Phone:310-707-2801
Practice Address - Fax:310-669-9501
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106S00000X, 225400000X
WASC615674841041C0700X
CA1246251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner