Healthcare Provider Details

I. General information

NPI: 1790234466
Provider Name (Legal Business Name): MARCO ANTONIO GOMEZ PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PLEASANT ST
NORTHAMPTON MA
01060-4127
US

IV. Provider business mailing address

5 WEST ST APT 5
EASTHAMPTON MA
01027-1325
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-6855
  • Fax: 413-585-1355
Mailing address:
  • Phone: 925-470-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10000078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: