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NPI Code Detail

MEDICARE: SUSANA GOMORA

MEDICARE: SUSANA GOMORA
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 WorkerLCSW60939CA
2101YM0800XMental Health Counselor23-QMHP-R-2008OR

General Provider Information

NPI Number : 1770764334
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANA GOMORA
Provider Business Mailing Address
First Line : 209 SW 4TH AVE STE 520
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1825
Country : US
Telephone Number : 503-988-5464
Fax Number : 503-988-4015
Provider Business Practice Location Address
First Line : 209 SW 4TH AVE STE 520
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1825
Country : US
Telephone Number : 971-710-4424
Fax Number : 503-988-4386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2007
Last Update Date : 06/14/2023

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Directions to “ SUSANA GOMORA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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