Provider Demographics
NPI:1689158545
Name:YSABEL GOMEZ CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:YSABEL GOMEZ CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YSABEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:978-990-6060
Mailing Address - Street 1:90 MADISON ST STE 302
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2072
Mailing Address - Country:US
Mailing Address - Phone:978-990-6060
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST FL 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2058
Practice Address - Country:US
Practice Address - Phone:978-990-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)