Healthcare Provider Details

I. General information

NPI: 1063335941
Provider Name (Legal Business Name): STEPHANIE GOMEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

V. Phone/Fax

Practice location:
  • Phone: 410-924-4066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: