Provider Demographics
NPI:1144413352
Name:GOMES, BENEDICTA F (MSW)
Entity Type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:F
Last Name:GOMES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4128
Mailing Address - Country:US
Mailing Address - Phone:857-212-3450
Mailing Address - Fax:
Practice Address - Street 1:52 JONES AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4128
Practice Address - Country:US
Practice Address - Phone:857-212-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health