Healthcare Provider Details

I. General information

NPI: 1083337737
Provider Name (Legal Business Name): CLAUDIO ELISEU DE PINA GOMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HYDE PARK AVE
HYDE PARK MA
02136-2819
US

IV. Provider business mailing address

19 MAIN ST APT 204
BROCKTON MA
02301-4456
US

V. Phone/Fax

Practice location:
  • Phone: 888-763-6262
  • Fax: 877-243-2959
Mailing address:
  • Phone: 888-763-7272
  • Fax: 877-243-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: