Healthcare Provider Details

I. General information

NPI: 1790615862
Provider Name (Legal Business Name): RITA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 GLENWOOD STATION LN UNIT 407
CHARLOTTESVILLE VA
22901-5721
US

IV. Provider business mailing address

1051 GLENWOOD STATION LN UNIT 407
CHARLOTTESVILLE VA
22901-5721
US

V. Phone/Fax

Practice location:
  • Phone: 434-222-0004
  • Fax:
Mailing address:
  • Phone: 757-777-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: