Provider Demographics
NPI:1043593429
Name:BREEDLOVE, GOMEL N (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GOMEL
Middle Name:N
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HART ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1122
Mailing Address - Country:US
Mailing Address - Phone:585-454-1095
Mailing Address - Fax:
Practice Address - Street 1:30 HART ST
Practice Address - Street 2:ROOM 402
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1122
Practice Address - Country:US
Practice Address - Phone:585-454-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045656-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator