Provider Demographics
NPI:1164065389
Name:GOMEZ, GISSELLA (BA)
Entity Type:Individual
Prefix:MRS
First Name:GISSELLA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 ASHURST ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2884
Mailing Address - Country:US
Mailing Address - Phone:407-867-8828
Mailing Address - Fax:
Practice Address - Street 1:4850 ASHURST ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2884
Practice Address - Country:US
Practice Address - Phone:407-867-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker