Provider Demographics
NPI:1922357227
Name:GOMEZ, DAVID (LMHC, BCBA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 NW 161ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6677
Mailing Address - Country:US
Mailing Address - Phone:305-607-2896
Mailing Address - Fax:
Practice Address - Street 1:16071 MICELLI DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-1821
Practice Address - Country:US
Practice Address - Phone:305-607-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11833858103K00000X
FLMH 13328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst