Provider Demographics
NPI:1396410924
Name:GOMEZ, SHARI FAITH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:FAITH
Last Name:GOMEZ
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 1:1741 EASTLAKE PARKWAY STE. 102
Mailing Address - Street 2:PMB #196
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:678-637-0054
Mailing Address - Fax:
Practice Address - Street 1:1741 EASTLAKE PARKWAY STE. 102
Practice Address - Street 2:PMB #196
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915
Practice Address - Country:US
Practice Address - Phone:678-637-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1258301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical