Provider Demographics
NPI:1922293604
Name:GOMEZ, KATHRYN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 W HUNTSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-3969
Mailing Address - Country:US
Mailing Address - Phone:559-638-3063
Mailing Address - Fax:
Practice Address - Street 1:83 E SHAW AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7620
Practice Address - Country:US
Practice Address - Phone:559-226-0167
Practice Address - Fax:559-226-1559
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical