Provider Demographics
NPI:1770284697
Name:JUAREZ GOMEZ, AZUCENY (MSW)
Entity type:Individual
Prefix:
First Name:AZUCENY
Middle Name:
Last Name:JUAREZ 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 1:9036 155TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3827
Mailing Address - Country:US
Mailing Address - Phone:347-279-9613
Mailing Address - Fax:
Practice Address - Street 1:9036 155TH ST FL 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3827
Practice Address - Country:US
Practice Address - Phone:347-279-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker