Provider Demographics
NPI:1881146439
Name:GOMEZ, BELEN (MFT)
Entity type:Individual
Prefix:
First Name:BELEN
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E LANCASTER AVE
Mailing Address - Street 2:APT 812
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1451
Mailing Address - Country:US
Mailing Address - Phone:786-566-1319
Mailing Address - Fax:
Practice Address - Street 1:2514 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-4013
Practice Address - Country:US
Practice Address - Phone:215-226-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist