Provider Demographics
NPI:1477686947
Name:GOMEZ, ANA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:L
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LOOKOUT PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4488
Mailing Address - Country:US
Mailing Address - Phone:407-927-8154
Mailing Address - Fax:
Practice Address - Street 1:202 LOOKOUT PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4488
Practice Address - Country:US
Practice Address - Phone:407-927-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical