Provider Demographics
NPI:1447468434
Name:GONZALEZ, RAQUEL MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 WINKLER RD STE 212
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7200
Mailing Address - Country:US
Mailing Address - Phone:239-939-3700
Mailing Address - Fax:239-939-3889
Practice Address - Street 1:6719 WINKLER RD STE 212
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7200
Practice Address - Country:US
Practice Address - Phone:239-939-3700
Practice Address - Fax:239-939-3889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00041381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical