Provider Demographics
NPI:1770096497
Name:GOMES, SANDRA RAQUEL (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:RAQUEL
Last Name:GOMES
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7488
Mailing Address - Country:US
Mailing Address - Phone:908-447-2904
Mailing Address - Fax:
Practice Address - Street 1:1810 BURNT MILLS RD
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2672
Practice Address - Country:US
Practice Address - Phone:908-719-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-14283OtherBEHAVIOR ANALYST CERTIFICATION BOARD