Provider Demographics
NPI:1760617666
Name:KELLY GOMEZ, DEBRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:KELLY GOMEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3220 HAVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7016
Mailing Address - Country:US
Mailing Address - Phone:630-991-6499
Mailing Address - Fax:630-851-0293
Practice Address - Street 1:1607 N AURORA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2784
Practice Address - Country:US
Practice Address - Phone:630-991-6499
Practice Address - Fax:844-348-3289
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-0874103TC0700X
IL071.007690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical