Healthcare Provider Details

I. General information

NPI: 1538446216
Provider Name (Legal Business Name): CAROL JOAN GOMEZ MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GRIFFIN AVE
LOS ANGELES CA
90031-3312
US

IV. Provider business mailing address

8600 TUSCANY AVE UNIT 201
PLAYA DEL REY CA
90293-8697
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-4134
  • Fax: 323-221-3231
Mailing address:
  • Phone: 617-448-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW29009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: