MEDICARE: JULIA LISBETH GOMEZ I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		NJ

General Provider Information

NPI Number	:	1508720616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA LISBETH GOMEZ I

Provider Business Mailing Address
First Line	:	2 BERNICE RD
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-1508
Country	:	US
Telephone Number	:	201-234-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 BERNICE RD
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-1508
Country	:	US
Telephone Number	:	201-234-1544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ JULIA LISBETH GOMEZ I ” Practice Location

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