Provider Demographics
NPI:1871277087
Name:GOMEZ, SAMANTHA AZUCENA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AZUCENA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4632
Mailing Address - Country:US
Mailing Address - Phone:602-405-7139
Mailing Address - Fax:
Practice Address - Street 1:5321 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1760
Practice Address - Country:US
Practice Address - Phone:602-405-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker