Provider Demographics
NPI:1821590035
Name:AGUILERA DE GOMEZ, MARIA ELENA (MSW, PPSC, ASW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:AGUILERA DE GOMEZ
Suffix:
Gender:F
Credentials:MSW, PPSC, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0946
Mailing Address - Country:US
Mailing Address - Phone:559-229-3569
Mailing Address - Fax:559-229-3861
Practice Address - Street 1:4545 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0946
Practice Address - Country:US
Practice Address - Phone:559-229-3569
Practice Address - Fax:559-229-3861
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81577101YM0800X
CAASW815771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty