Healthcare Provider Details

I. General information

NPI: 1003283433
Provider Name (Legal Business Name): ARAM FEDERICO GOMEZ LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BRADY RD
MADRID NY
13660-3166
US

IV. Provider business mailing address

501 BRADY RD
MADRID NY
13660-3166
US

V. Phone/Fax

Practice location:
  • Phone: 315-276-9272
  • Fax:
Mailing address:
  • Phone: 315-322-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: