MEDICARE: STELLA CHRISTINA GOMEZ LMSW

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	104100000X	Social Worker	SWB-2023-0955	NM

General Provider Information

NPI Number	:	1639945876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA CHRISTINA GOMEZ LMSW

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	TESUQUE
State	:	NM
Zip	:	87574-0449
Country	:	US
Telephone Number	:	505-983-6158
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 OFFICE COURT DR STE 906
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-4929
Country	:	US
Telephone Number	:	505-310-5654
Fax Number	:

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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