Provider Demographics
NPI:1578865655
Name:GOMES, MALAQUIAS (MALKES)
Entity Type:Individual
Prefix:MR
First Name:MALAQUIAS (MALKES)
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-6700
Mailing Address - Country:US
Mailing Address - Phone:781-885-7252
Mailing Address - Fax:781-885-7256
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-6700
Practice Address - Country:US
Practice Address - Phone:781-885-7252
Practice Address - Fax:781-885-7256
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health