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General NPI Number Information
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NPI Number | 1902167570
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Entity Type | Individual
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Provider Name | KATHERINE GOMATOS MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1133 LOUISIANA AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-2343
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Country | US
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Telephone | 407-602-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 8439 FOXWORTH CIR
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City | ORLANDO
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State | FL
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Zip | 32819-5036
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Country | US
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Telephone | 407-602-5300
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW13466
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License Number State | FL
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