Provider Demographics
NPI:1386303857
Name:GOMEZ-MADERA, GIANNY
Entity type:Individual
Prefix:
First Name:GIANNY
Middle Name:
Last Name:GOMEZ-MADERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIANNY
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:362 CHESTNUT CT APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2658
Mailing Address - Country:US
Mailing Address - Phone:347-678-9136
Mailing Address - Fax:
Practice Address - Street 1:2552 PITKIN AVE STE 3
Practice Address - Street 2:#1016
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:347-678-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A