Provider Demographics
NPI:1013653054
Name:GOMEZ MARTINEZ, JAVIER
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:GOMEZ MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W 151ST ST APT 26
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-2113
Mailing Address - Country:US
Mailing Address - Phone:718-308-1952
Mailing Address - Fax:
Practice Address - Street 1:609 W 151ST ST APT 26
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-2113
Practice Address - Country:US
Practice Address - Phone:718-308-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health