Provider Demographics
NPI:1972205037
Name:ROA GONZALEZ, MANUELA (MSW, SWC)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:ROA GONZALEZ
Suffix:
Gender:F
Credentials:MSW, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-8480
Mailing Address - Country:US
Mailing Address - Phone:510-520-7044
Mailing Address - Fax:
Practice Address - Street 1:698 BRIGG ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:510-520-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.0000001198104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker