Provider Demographics
NPI:1447701222
Name:GONZALES, LORRAINE (ACSW REG 34032)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:ACSW REG 34032
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3538
Mailing Address - Country:US
Mailing Address - Phone:909-793-4508
Mailing Address - Fax:909-798-8071
Practice Address - Street 1:710 CHURCH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3538
Practice Address - Country:US
Practice Address - Phone:909-793-4508
Practice Address - Fax:909-798-8071
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor