Provider Demographics
NPI:1205697935
Name:GOMES, MAICA DEPINA JR
Entity type:Individual
Prefix:
First Name:MAICA
Middle Name:DEPINA
Last Name:GOMES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5606
Mailing Address - Country:US
Mailing Address - Phone:617-606-2005
Mailing Address - Fax:
Practice Address - Street 1:400 WASHIGNTON ST
Practice Address - Street 2:BRAINTREE
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:857-939-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker