Provider Demographics
NPI:1124641485
Name:GOMEZ, YESENIA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:
Other - Last Name:PALMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4190 MONAGHAN WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-2762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 TECHNOLOGY PKWY S
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2996
Practice Address - Country:US
Practice Address - Phone:833-628-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician