Provider Demographics
NPI:1093686057
Name:VASQUEZ GOMEZ, ANA MARIA (LMFT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:VASQUEZ GOMEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 N MONTICELLO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5852
Mailing Address - Country:US
Mailing Address - Phone:315-728-8348
Mailing Address - Fax:
Practice Address - Street 1:4633 N MONTICELLO AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5852
Practice Address - Country:US
Practice Address - Phone:315-728-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist