Provider Demographics
NPI:1700287109
Name:GOMEZ, SAUL BENJAMIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAUL
Middle Name:BENJAMIN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 41ST ST APT F10
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3544
Mailing Address - Country:US
Mailing Address - Phone:718-501-5494
Mailing Address - Fax:
Practice Address - Street 1:380 LEXINGTON AVE
Practice Address - Street 2:17TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-0002
Practice Address - Country:US
Practice Address - Phone:718-501-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical