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General NPI Number Information
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NPI Number | 1699071969
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE GOMEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 3345 WESTERN CENTER BLVD STE 140
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City | FORT WORTH
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State | TX
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Zip | 76137-1938
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Country | US
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Telephone | 817-269-7060
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Fax | 817-636-2704
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Provider Business Mailing Address
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Address Line | 805 CONESTOGA TRL
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City | RHOME
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State | TX
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Zip | 76078-4216
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Country | US
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Telephone | 817-269-7060
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Fax | 877-275-1630
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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 | 32319
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License Number State | TX
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