Provider Demographics
NPI:1952892838
Name:GOMEZ CHIANG, JORGE D (CBHCM)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:D
Last Name:GOMEZ CHIANG
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 W FLAGLER ST APT 403
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2839
Mailing Address - Country:US
Mailing Address - Phone:786-805-1897
Mailing Address - Fax:
Practice Address - Street 1:8910 MIRAMAR PKWY STE 207C
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4961
Practice Address - Country:US
Practice Address - Phone:954-696-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM101761-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker