Healthcare Provider Details

I. General information

NPI: 1649190265
Provider Name (Legal Business Name): SKYROCKET BEHAVIORAL SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

IV. Provider business mailing address

7376 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

V. Phone/Fax

Practice location:
  • Phone: 561-788-4086
  • Fax:
Mailing address:
  • Phone: 561-788-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: FABIANA GOMEZ
Title or Position: OWNER
Credential:
Phone: 561-475-6308