Provider Demographics
NPI:1558929166
Name:GONZALEZ, MARCI JANELLE
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:JANELLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 ROARING RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9308
Mailing Address - Country:US
Mailing Address - Phone:661-497-9499
Mailing Address - Fax:
Practice Address - Street 1:11907 STURGEON CREEK DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9261
Practice Address - Country:US
Practice Address - Phone:661-497-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1310201041C0700X, 104100000X
171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program