Provider Demographics
NPI:1932979598
Name:GOMEZ BEHAVIORAL THERAPY LLC
Entity Type:Organization
Organization Name:GOMEZ BEHAVIORAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ VERDECIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-340-6990
Mailing Address - Street 1:12356 SW 197TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4950
Mailing Address - Country:US
Mailing Address - Phone:786-340-6990
Mailing Address - Fax:
Practice Address - Street 1:12356 SW 197TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4950
Practice Address - Country:US
Practice Address - Phone:786-340-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty