Provider Demographics
NPI:1982891404
Name:GOMEZ, MAYRA D (MSW, ASW)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:D
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 RANCHITO DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1411
Mailing Address - Country:US
Mailing Address - Phone:415-830-2632
Mailing Address - Fax:
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:510-893-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker