Provider Demographics
NPI:1710609987
Name:GOMEZ, MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1286
Mailing Address - Country:US
Mailing Address - Phone:616-251-9171
Mailing Address - Fax:
Practice Address - Street 1:295 N 3855 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5124
Practice Address - Country:US
Practice Address - Phone:208-745-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID42674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker