Provider Demographics
NPI:1750788295
Name:GOMEZ, ANTOINETTE MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MARIA
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 1:18230 E SILVER CREEK AVE BLDG 392
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9501
Mailing Address - Country:US
Mailing Address - Phone:720-847-6451
Mailing Address - Fax:
Practice Address - Street 1:18230 E SILVER CREEK AVE BLDG 392
Practice Address - Street 2:
Practice Address - City:BUCKLEY SFB
Practice Address - State:CO
Practice Address - Zip Code:80011-9501
Practice Address - Country:US
Practice Address - Phone:720-847-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-27
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0007304101YA0400X
COMFT.0001713106H00000X
COCSW.099233551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist