Provider Demographics
NPI:1255409611
Name:GOMEZ-KLEIN, BEATRIZ ELISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:ELISA
Last Name:GOMEZ-KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DREW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4747
Mailing Address - Country:US
Mailing Address - Phone:973-837-0286
Mailing Address - Fax:973-226-0866
Practice Address - Street 1:12 SMULL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5012
Practice Address - Country:US
Practice Address - Phone:973-837-0286
Practice Address - Fax:973-226-0866
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000106001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ045893Medicare ID - Type Unspecified