Provider Demographics
NPI:1104483031
Name:GOMEZ NUNEZ, MONTSERRAT (LPCC)
Entity type:Individual
Prefix:
First Name:MONTSERRAT
Middle Name:
Last Name:GOMEZ NUNEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARIA DE
Other - Middle Name:MONTSERRAT
Other - Last Name:GOMEZ NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5165
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-8493
Mailing Address - Fax:
Practice Address - Street 1:8110 BIRMINGHAM WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2758
Practice Address - Country:US
Practice Address - Phone:858-966-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC13762101YM0800X
CAAPCC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health