Provider Demographics
NPI:1740790971
Name:GOMART, EMILIE MARIE-DOMINIQUE (MSC)
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:MARIE-DOMINIQUE
Last Name:GOMART
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:M
Other - Last Name:BERG-GOMART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5305 BLACKISTONE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1822
Mailing Address - Country:US
Mailing Address - Phone:301-767-6879
Mailing Address - Fax:
Practice Address - Street 1:13200 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3433
Practice Address - Country:US
Practice Address - Phone:301-960-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist