Provider Demographics
NPI:1972020030
Name:JORGE GOMEZ, CLARA IVON
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:IVON
Last Name:JORGE GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8975 OKEECHOBEE BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5133
Mailing Address - Country:US
Mailing Address - Phone:561-260-6871
Mailing Address - Fax:
Practice Address - Street 1:8975 OKEECHOBEE BLVD APT 303
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5133
Practice Address - Country:US
Practice Address - Phone:561-260-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-65741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst