Provider Demographics
NPI:1467290650
Name:GONZALEZ, JESSICA NICHOLE (MSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICHOLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10299 CORALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3061
Mailing Address - Country:US
Mailing Address - Phone:209-872-3337
Mailing Address - Fax:530-767-4355
Practice Address - Street 1:140 E COMMONWEALTH AVE STE 208
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1905
Practice Address - Country:US
Practice Address - Phone:949-610-8966
Practice Address - Fax:530-767-4355
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA904521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical