Provider Demographics
NPI:1003313388
Name:GOMES, ELENICE
Entity Type:Individual
Prefix:
First Name:ELENICE
Middle Name:
Last Name:GOMES
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 1:1810 SULLIVANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1055
Mailing Address - Country:US
Mailing Address - Phone:614-752-0333
Mailing Address - Fax:614-995-3268
Practice Address - Street 1:1810 SULLIVANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1055
Practice Address - Country:US
Practice Address - Phone:614-752-0333
Practice Address - Fax:614-995-3268
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS17014091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical