Provider Demographics
NPI:1851673032
Name:GOMES, ALFRED L JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:L
Last Name:GOMES
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HANOVER LN STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7224
Mailing Address - Country:US
Mailing Address - Phone:530-965-1041
Mailing Address - Fax:
Practice Address - Street 1:48 HANOVER LN STE 2
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7224
Practice Address - Country:US
Practice Address - Phone:530-965-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA765791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851673062OtherNPI NUMGER
CA1851673032OtherNPI NUMBER