Provider Demographics
NPI:1821327891
Name:GOMEZ, JUANITA CAMPOS (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:CAMPOS
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JUANITA
Other - Middle Name:C
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8014 AGUA DULCE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3890
Mailing Address - Country:US
Mailing Address - Phone:956-249-0679
Mailing Address - Fax:
Practice Address - Street 1:3722 SUNSHINE RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-2509
Practice Address - Country:US
Practice Address - Phone:956-249-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical