Provider Demographics
NPI:1508570763
Name:GOMEZ, MELANIE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
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 1:3240 S GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7524
Mailing Address - Country:US
Mailing Address - Phone:322-236-1588
Mailing Address - Fax:
Practice Address - Street 1:1221 S CLARKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1625
Practice Address - Country:US
Practice Address - Phone:720-729-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical