Healthcare Provider Details

I. General information

NPI: 1922545011
Provider Name (Legal Business Name): MADIBET GOMEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PEERLESS ST
CRANSTON RI
02910-2561
US

IV. Provider business mailing address

118 PEERLESS ST
CRANSTON RI
02910-2561
US

V. Phone/Fax

Practice location:
  • Phone: 401-996-1926
  • Fax:
Mailing address:
  • Phone: 401-996-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01963
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: