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Provider Information for 1720566391

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALICIA MARIE GOMEZ LICSW

Gender: FEMALE

Individual NPI: 1720566391

Calendar   Last Updated:  2018-08-05
  Certification Date: 

Details

Name Value
NPI 1720566391
Enumeration Date 2018-08-05
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 32 HERITAGE RD
DRACUT, MA 01826-4300
United States

Phone: 978-606-7109 | Fax:
View Map External Link
Primary Practice Address 32 HERITAGE RD
DRACUT, MA 01826-4300
United States

Phone: 978-606-7109 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 113129
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1041C0700X - Social Worker Clinical MA 113129