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General NPI Number Information
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NPI Number | 1366114910
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Entity Type | Individual
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Provider Name | SANDRA J GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 303 5TH AVE RM 1917
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City | NEW YORK
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State | NY
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Zip | 10016-6629
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Country | US
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Telephone | 646-844-4762
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Fax |
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Provider Business Mailing Address
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Address Line | 1558 GREENVIEW DR
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City | BETHLEHEM
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State | PA
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Zip | 18018-1727
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Country | US
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Telephone | 201-486-6516
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P112094
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 014460
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License Number State | NY
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