Provider Demographics
NPI:1114295375
Name:GOMEZ, GERTRUDE K (MSW, P-LCSW)
Entity Type:Individual
Prefix:MISS
First Name:GERTRUDE
Middle Name:K
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2866
Mailing Address - Country:US
Mailing Address - Phone:336-471-0451
Mailing Address - Fax:
Practice Address - Street 1:1611 CASTLE HAYNE RD
Practice Address - Street 2:SUITE G1A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8859
Practice Address - Country:US
Practice Address - Phone:910-815-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0069241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical