MEDICARE: MADIBET GOMEZ LMHC

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	101YM0800X	Mental Health Counselor	MHC01963	RI

General Provider Information

NPI Number	:	1922545011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADIBET GOMEZ LMHC

Provider Business Mailing Address
First Line	:	118 PEERLESS ST
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-2561
Country	:	US
Telephone Number	:	401-996-1926
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 PEERLESS ST
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-2561
Country	:	US
Telephone Number	:	401-996-1926
Fax Number	:

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

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	12/08/2025

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