Provider Demographics
NPI:1275382293
Name:RODELA-GOMEZ, LIANNA (LMSW)
Entity type:Individual
Prefix:
First Name:LIANNA
Middle Name:
Last Name:RODELA-GOMEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7493 N ORACLE RD STE 125
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6328
Mailing Address - Country:US
Mailing Address - Phone:520-556-2062
Mailing Address - Fax:
Practice Address - Street 1:7493 N ORACLE RD STE 125
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6328
Practice Address - Country:US
Practice Address - Phone:520-556-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20887104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker