Provider Demographics
NPI:1770917213
Name:GOMEZ, VERONICA (LICENSED)
Entity type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 4050
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9604
Mailing Address - Country:US
Mailing Address - Phone:787-435-7968
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 4050
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9604
Practice Address - Country:US
Practice Address - Phone:787-435-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-01
Last Update Date:2013-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5210103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist