MEDICARE: MARISSA D RODRIGUEZ GOMES LSW

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	2255A2300X	Athletic Trainer	F5340450	CA
2	104100000X	Social Worker	44SL07393900	NJ
3	1041S0200X	School Social Worker	01724051	NJ
4	2255A2300X	Athletic Trainer	716767053	NY
5	1041S0200X	School Social Worker	1933343251	NY
6	104100000X	Social Worker	126020	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902489040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA D RODRIGUEZ GOMES LSW

Provider Business Mailing Address
First Line	:	192 LAUREL AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-1331
Country	:	US
Telephone Number	:	559-903-1953
Fax Number	:

Provider Business Practice Location Address
First Line	:	192 LAUREL AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-1331
Country	:	US
Telephone Number	:	559-903-1953
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	06/09/2026

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