Provider Demographics
NPI:1255343604
Name:GOMEZ, MARTHA I (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:I
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8853 COMMODITY CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9010
Mailing Address - Country:US
Mailing Address - Phone:407-226-6898
Mailing Address - Fax:407-331-4616
Practice Address - Street 1:8853 COMMODITY CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9010
Practice Address - Country:US
Practice Address - Phone:407-226-6898
Practice Address - Fax:407-331-4616
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7216103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist