Provider Demographics
NPI:1730421744
Name:GOMEZ, LAURA MARIA (MSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIA
Last Name: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 1:91 LUIS MUNOS RIVERA
Mailing Address - Street 2:SUITE 91
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00757
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 LUIS MUNOZ RIVERA
Practice Address - Street 2:SUITE 91
Practice Address - City:SANTA ISABEL
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00757
Practice Address - Country:UM
Practice Address - Phone:787-845-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical