Provider Demographics
NPI:1396948717
Name:GOMEZ, MARCELO (MSW)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2941
Mailing Address - Country:US
Mailing Address - Phone:973-857-9030
Mailing Address - Fax:973-857-9036
Practice Address - Street 1:25 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2941
Practice Address - Country:US
Practice Address - Phone:973-857-9030
Practice Address - Fax:973-857-9036
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor