Healthcare Provider Details

I. General information

NPI: 1417430836
Provider Name (Legal Business Name): LAURA ASHLEY GOMEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 RESEDA BLVD
NORTHRIDGE CA
91324-4619
US

IV. Provider business mailing address

8330 RESEDA BLVD
NORTHRIDGE CA
91324-4619
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax:
Mailing address:
  • Phone: 818-996-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: