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General NPI Number Information
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NPI Number | 1689230955
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Entity Type | Individual
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Provider Name | MARK CALEB GOMEZ LMSW
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Gender | Male
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 7850 JEFFERSON ST NE STE 300
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4314
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Country | US
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Telephone | 505-884-1114
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Fax | 505-884-3004
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Provider Business Mailing Address
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Address Line | 10555 MONTGOMERY BLVD NE BLDG 2
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3857
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Country | US
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Telephone | 505-503-7946
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Fax | 505-503-7947
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2024-0139
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License Number State | NM
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