Provider Demographics
NPI:1548853641
Name:HERNANDEZ GOMEZ, VANESSA M (MSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:HERNANDEZ GOMEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 AIKEN ST APT G3
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2126
Mailing Address - Country:US
Mailing Address - Phone:914-943-7169
Mailing Address - Fax:
Practice Address - Street 1:120 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5703
Practice Address - Country:US
Practice Address - Phone:203-750-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker