Healthcare Provider Details

I. General information

NPI: 1669056883
Provider Name (Legal Business Name): ERICA ILDEFONSO GOMEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500B JEFFERSON BLVD STE 195
WEST SACRAMENTO CA
95605-2349
US

IV. Provider business mailing address

500 JEFFERSON BLVD STE B195
WEST SACRAMENTO CA
95605-2350
US

V. Phone/Fax

Practice location:
  • Phone: 916-403-2970
  • Fax:
Mailing address:
  • Phone: 916-403-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139227
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: