Provider Demographics
NPI:1255653689
Name:VILLAR-GOMEZ, JUANA ISABEL (LICSW, CDP)
Entity Type:Individual
Prefix:MISS
First Name:JUANA
Middle Name:ISABEL
Last Name:VILLAR-GOMEZ
Suffix:
Gender:F
Credentials:LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5007 CLAREMONT WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-3321
Practice Address - Country:US
Practice Address - Phone:425-605-5505
Practice Address - Fax:425-609-5506
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079803104100000X
WALW604849461041C0700X, 1041S0200X
NY20908101YA0400X
WACP60483694101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool