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NPI Code Detail

MEDICARE: MARIA GOMEZ LCSW

MEDICARE: MARIA 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
11041C0700XClinical Social Worker8911144ID

General Provider Information

NPI Number : 1710609987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA GOMEZ LCSW
Provider Business Mailing Address
First Line : 2265 W BROADWAY ST
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83402-2996
Country : US
Telephone Number : 208-524-7400
Fax Number : 208-524-8004
Provider Business Practice Location Address
First Line : 2265 W BROADWAY ST
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83402-2996
Country : US
Telephone Number : 208-524-7400
Fax Number : 208-524-8004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2022
Last Update Date : 03/04/2026

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Directions to “ MARIA GOMEZ LCSW” Practice Location

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