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NPI Code Detail

MEDICARE: MARISOL RUEDA GOMEZ LMSW

MEDICARE: MARISOL RUEDA 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
1104100000XSocial Worker

General Provider Information

NPI Number : 1972907996
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISOL RUEDA GOMEZ LMSW
Provider Business Mailing Address
First Line : 8709 30TH AVE
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11369-1430
Country : US
Telephone Number : 917-435-0544
Fax Number :
Provider Business Practice Location Address
First Line : 9114 MERRICK BLVD STE 3
Second Line :
City : JAMAICA
State : NY
Zip : 11432-5363
Country : US
Telephone Number : 718-206-3440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2014
Last Update Date : 01/22/2025

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