Provider Demographics
NPI:1629682109
Name:GOMEZ, STEPHANIE JESSICA (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JESSICA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 PRICKLY OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-4596
Mailing Address - Country:US
Mailing Address - Phone:210-860-1335
Mailing Address - Fax:
Practice Address - Street 1:8219 PRICKLY OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-4596
Practice Address - Country:US
Practice Address - Phone:210-860-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical