Provider Demographics
NPI:1447606678
Name:GOMEZ, CARINA (LCAT)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 GREAT HILLS TRL APT 1103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5846
Mailing Address - Country:US
Mailing Address - Phone:443-844-6795
Mailing Address - Fax:
Practice Address - Street 1:113 E 60TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1939
Practice Address - Country:US
Practice Address - Phone:917-828-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002161-1101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor