Provider Demographics
NPI:1568640712
Name:GONZALES, PATRICIA DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:GONZALES
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:GONZALES-URIOSTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1574 STATE ROAD 502
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-2697
Mailing Address - Country:US
Mailing Address - Phone:505-455-0801
Mailing Address - Fax:
Practice Address - Street 1:1574 STATE ROAD 502
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-2697
Practice Address - Country:US
Practice Address - Phone:505-455-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-33281041S0200X
NMC-109751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78980569Medicaid