Provider Demographics
NPI:1053780296
Name:GONZALEZ, NINA (MSW)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 INVERRARY BLVD
Mailing Address - Street 2:SUITE #404-A
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4356
Mailing Address - Country:US
Mailing Address - Phone:954-474-7373
Mailing Address - Fax:954-449-0522
Practice Address - Street 1:3810 INVERRARY BLVD
Practice Address - Street 2:SUITE #404-A
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4356
Practice Address - Country:US
Practice Address - Phone:954-474-7373
Practice Address - Fax:954-449-0522
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013693000Medicaid