Provider Demographics
NPI:1649753690
Name:GOMEZ, MARIA D (CDPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 S ANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1712
Mailing Address - Country:US
Mailing Address - Phone:206-461-4880
Mailing Address - Fax:206-461-6989
Practice Address - Street 1:3808 S.ANGELINE ST.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-9811
Practice Address - Country:US
Practice Address - Phone:206-461-4880
Practice Address - Fax:206-461-6989
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60718189101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)