Provider Demographics
NPI:1538328976
Name:GOMEZ, CASSANDRA PATRICIA (MA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:PATRICIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1740
Mailing Address - Country:US
Mailing Address - Phone:612-378-2363
Mailing Address - Fax:612-378-2215
Practice Address - Street 1:3433 BROADWAY ST NE
Practice Address - Street 2:SUITE 160
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1740
Practice Address - Country:US
Practice Address - Phone:612-378-2363
Practice Address - Fax:612-378-2215
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional