Provider Demographics
NPI:1417834599
Name:GOMES, JENNIFER LEE (LLMSW)
Entity type:Individual
Prefix:PROF
First Name:JENNIFER
Middle Name:LEE
Last Name:GOMES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:MATAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3493 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-3629
Mailing Address - Country:US
Mailing Address - Phone:727-277-1143
Mailing Address - Fax:727-277-1143
Practice Address - Street 1:3493 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3629
Practice Address - Country:US
Practice Address - Phone:727-277-1143
Practice Address - Fax:727-277-1143
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117447104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker