Provider Demographics
NPI:1205096385
Name:GOMES, RONIE L
Entity type:Individual
Prefix:DR
First Name:RONIE
Middle Name:L
Last Name:GOMES
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 1:10437 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5607
Mailing Address - Country:US
Mailing Address - Phone:954-680-1630
Mailing Address - Fax:
Practice Address - Street 1:1061 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1609
Practice Address - Country:US
Practice Address - Phone:954-567-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist