Provider Demographics
NPI:1831972199
Name:GOMEZ, TERRI E (LBSW)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:E
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-1713
Mailing Address - Country:US
Mailing Address - Phone:575-542-9361
Mailing Address - Fax:
Practice Address - Street 1:401 HIGH ST
Practice Address - Street 2:
Practice Address - City:LORDSBURG
Practice Address - State:NM
Practice Address - Zip Code:88045-1713
Practice Address - Country:US
Practice Address - Phone:575-542-9361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-0203104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker