Provider Demographics
NPI:1790664407
Name:FLOREZ-GOMEZ, LAURA (PSY D)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:FLOREZ-GOMEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N FULTON AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1506
Mailing Address - Country:US
Mailing Address - Phone:914-837-9598
Mailing Address - Fax:
Practice Address - Street 1:119 N FULTON AVE # 1
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1506
Practice Address - Country:US
Practice Address - Phone:914-837-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist