Provider Demographics
NPI:1881759900
Name:GOMEZ, MARIO RAMON (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:RAMON
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:MR
Other - First Name:MARIO
Other - Middle Name:RAMON
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:93 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4503
Mailing Address - Country:US
Mailing Address - Phone:917-375-6275
Mailing Address - Fax:
Practice Address - Street 1:1963 GRAND CONCOURSE
Practice Address - Street 2:605WEST 177STREET,NEW YORK, NY10033, SUITE LL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4929
Practice Address - Country:US
Practice Address - Phone:917-375-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR06534211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical