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General NPI Number Information
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NPI Number | 1760617666
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Entity Type | Individual
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Provider Name | DEBRA KELLY GOMEZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 1607 N AURORA RD SUITE 204
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City | NAPERVILLE
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State | IL
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Zip | 60563-2784
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Country | US
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Telephone | 630-991-6499
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Fax | 844-348-3289
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Provider Business Mailing Address
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Address Line | 3220 HAVERHILL DR
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City | AURORA
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State | IL
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Zip | 60502-7016
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Country | US
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Telephone | 630-991-6499
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Fax | 630-851-0293
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3-0874
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.007690
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License Number State | IL
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