Provider Demographics
NPI:1619401924
Name:GOMEZ, GUILLERMO ANTONIO JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:ANTONIO
Last Name:GOMEZ
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1825 NW 167TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33056
Mailing Address - Country:US
Mailing Address - Phone:305-474-1749
Mailing Address - Fax:305-623-7893
Practice Address - Street 1:1825 NW 167TH ST
Practice Address - Street 2:SUIT 102
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-474-1749
Practice Address - Fax:305-623-7893
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical