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General NPI Number Information
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NPI Number | 1265881064
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Entity Type | Individual
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Provider Name | COLETTE GOMEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 121 N MITCHELL ST
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City | CADILLAC
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State | MI
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Zip | 49601-1879
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Country | US
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Telephone | 989-202-2803
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 595
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City | CADILLAC
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State | MI
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Zip | 49601-0595
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Country | US
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Telephone | 989-202-2803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801111313
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License Number State | MI
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