Provider Demographics
NPI:1336281229
Name:HERNANDEZ-GOMEZ, ROSA ELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ELIA
Last Name:HERNANDEZ-GOMEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31946 MISSION TRAIL
Mailing Address - Street 2:STE B
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530
Mailing Address - Country:US
Mailing Address - Phone:951-245-7717
Mailing Address - Fax:951-674-6431
Practice Address - Street 1:31946 MISSION TRAIL
Practice Address - Street 2:STE B
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:951-245-7717
Practice Address - Fax:951-674-6431
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 215621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical