MEDICARE: MARK ANDREW GOMEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	104483	TX

General Provider Information

NPI Number	:	1508643537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDREW GOMEZ LCSW

Provider Business Mailing Address
First Line	:	4927 ORCHID STAR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-2729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4927 ORCHID STAR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-2729
Country	:	US
Telephone Number	:	210-833-0289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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