Healthcare Provider Details

I. General information

NPI: 1376460089
Provider Name (Legal Business Name): TANYA YARETZY GOMEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 EMMAUS RD
ROCKINGHAM VA
22801-2685
US

IV. Provider business mailing address

7758 RISING CREEK LN
BROADWAY VA
22815-2626
US

V. Phone/Fax

Practice location:
  • Phone: 540-437-1605
  • Fax: 540-437-1606
Mailing address:
  • Phone: 540-437-1605
  • Fax: 540-437-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020680
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: