Basic Information
| Provider Information | |||||||||
| NPI: | 1487244315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | MERCY | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4653 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432133298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143847798 | ||||||||
| FaxNumber: | 6143847703 | ||||||||
| Practice Location | |||||||||
| Address1: | 774 INTERNET DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432072589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144435454 | ||||||||
| FaxNumber: | 6147375248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2021 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.2004928 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.