Provider Demographics
NPI:1952172918
Name:GOMEZ, ANA IRIS (LSW)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:IRIS
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 1:323 AUTUMN POND WAY UNIT 208
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4077
Mailing Address - Country:US
Mailing Address - Phone:732-925-3884
Mailing Address - Fax:
Practice Address - Street 1:128 LAKESIDE AVE STE 260
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5911
Practice Address - Country:US
Practice Address - Phone:802-657-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06927300104100000X
NY122065104100000X
VT156.0134174104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker