Provider Demographics
NPI:1598801201
Name:GONZALEZ, CAMILO (MSW)
Entity type:Individual
Prefix:MR
First Name:CAMILO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24660 AMADOR ST APT 209
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-2156
Mailing Address - Country:US
Mailing Address - Phone:650-244-0305
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:24660 AMADOR ST APT 209
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2156
Practice Address - Country:US
Practice Address - Phone:650-771-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA091920101Y00000X, 101YA0400X, 101YM0800X
101YA0400X, 171M00000X
CA1208841041C0700X, 1041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99037OtherOLLIN- PROP. 36
CA38932OtherAVIVA- MOM
CA97037OtherOLLIN
CA38241OtherHORIZONS UNLIMITED
CA41491OtherENTRE FAMILIA - OP
CA38472OtherQUETZAL
CA38935OtherAVIVA- BABIES