Provider Demographics
NPI:1538044086
Name:GOMEZ, GABRIEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 VINEYARD WAY
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9184
Mailing Address - Country:US
Mailing Address - Phone:859-382-9896
Mailing Address - Fax:
Practice Address - Street 1:2220 YOUNG DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4219
Practice Address - Country:US
Practice Address - Phone:859-277-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043955A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist