Provider Demographics
NPI:1538330162
Name:GOMEZ-AGUILERA, DANIEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:GOMEZ-AGUILERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:A
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:35 PARK AVE APT 10D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3842
Mailing Address - Country:US
Mailing Address - Phone:917-817-6008
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0816
Practice Address - Country:US
Practice Address - Phone:917-817-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0768881041C0700X, 1041C0700X
NJ37LC00152200101YA0400X
NJ44SC053660001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)