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General NPI Number Information
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NPI Number | 1417572272
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Entity Type | Individual
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Provider Name | HANNAH JOSSEN GOMEZ MA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 6635 EAST 21ST STREET WEST BUILDING
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-2254
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Country | US
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Telephone | 317-608-2824
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Fax | 317-520-8200
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Provider Business Mailing Address
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Address Line | 311 BOULEVARD OF AMERICAS STE 304
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4960
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Country | US
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Telephone | 402-252-1363
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-42148
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License Number State | IN
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