Provider Demographics
NPI:1639575707
Name:GOMEZ, CHLOE ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:ALEXANDRA
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 1:521 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2148
Mailing Address - Country:US
Mailing Address - Phone:213-623-2916
Mailing Address - Fax:213-622-1801
Practice Address - Street 1:521 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2148
Practice Address - Country:US
Practice Address - Phone:213-623-2916
Practice Address - Fax:213-622-1801
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical