Provider Demographics
NPI:1558814616
Name:GOMEZ, MARIA DEL ROSARIO
Entity Type:Individual
Prefix:
First Name:MARIA DEL ROSARIO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 OLD COLUMBIA PIKE APT 402
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1923
Mailing Address - Country:US
Mailing Address - Phone:301-328-0538
Mailing Address - Fax:
Practice Address - Street 1:12001 OLD COLUMBIA PIKE APT 402
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1923
Practice Address - Country:US
Practice Address - Phone:301-328-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500808941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical