Basic Information
| Provider Information | |||||||||
| NPI: | 1386379428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ-MORA | ||||||||
| FirstName: | DEYANIRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5116 VILLA BELLA LN | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933119595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613426138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 STINE RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933094827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667076664 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW107680 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.