Provider Demographics
NPI:1376294090
Name:GOMES, MARCELO DAMASCENO (PSYCHOANALYST)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:DAMASCENO
Last Name:GOMES
Suffix:
Gender:M
Credentials:PSYCHOANALYST
Other - Prefix:DR
Other - First Name:MARCELO
Other - Middle Name:D
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOANALYST
Mailing Address - Street 1:64 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7258
Mailing Address - Country:US
Mailing Address - Phone:305-713-8977
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:774-418-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0133630102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst