Provider Demographics
NPI:1780497891
Name:GOMEZ, MARIANA (LSW)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E HARWOOD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5738
Mailing Address - Country:US
Mailing Address - Phone:954-610-4402
Mailing Address - Fax:
Practice Address - Street 1:397 WEKIVA SPRINGS RD STE 205
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3697
Practice Address - Country:US
Practice Address - Phone:407-405-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health