Provider Demographics
NPI:1528582301
Name:ALCANTAR-GOMEZ, ALEJANDRO (ACSW)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:ALCANTAR-GOMEZ
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-5319
Mailing Address - Country:US
Mailing Address - Phone:661-397-8775
Mailing Address - Fax:661-397-8286
Practice Address - Street 1:217 W KERN AVE
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-1360
Practice Address - Country:US
Practice Address - Phone:661-792-3038
Practice Address - Fax:661-792-6270
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW118549104100000X
171M00000X
CA1185491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator