Provider Demographics
NPI:1902263296
Name:GONZALEZ, DIANA WEYN (LAC, MSW, AASW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:WEYN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LAC, MSW, AASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3323
Mailing Address - Country:US
Mailing Address - Phone:845-729-4079
Mailing Address - Fax:
Practice Address - Street 1:13731 E RICE PL STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1077
Practice Address - Country:US
Practice Address - Phone:845-729-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00012321041C0700X
CO.0000904101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical