Healthcare Provider Details

I. General information

NPI: 1801636451
Provider Name (Legal Business Name): BIANCA CECILIA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LITCHFIELD ST
TORRINGTON CT
06790-6424
US

IV. Provider business mailing address

127 MIDDLESEX ST
WATERBURY CT
06704-1338
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-3391
  • Fax:
Mailing address:
  • Phone: 203-721-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3407
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: