Provider Demographics
NPI:1891055703
Name:GOMEZ-GILLARD, PATRICIA MIRIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MIRIAM
Last Name:GOMEZ-GILLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PATTY
Other - Middle Name:MIRIAM
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1725 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1718
Mailing Address - Country:US
Mailing Address - Phone:530-262-1853
Mailing Address - Fax:
Practice Address - Street 1:1725 OREGON ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1718
Practice Address - Country:US
Practice Address - Phone:530-262-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS28005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health