Provider Demographics
NPI:1396239026
Name:GOMEZ, LINDSAY ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:ANN
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:ANN
Other - Last Name:MENGEBIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1115 BALL AVE NE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505
Mailing Address - Country:US
Mailing Address - Phone:616-456-7775
Mailing Address - Fax:616-451-8779
Practice Address - Street 1:1115 BALL AVE NE
Practice Address - Street 2:BUILDING B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-456-7775
Practice Address - Fax:616-451-8779
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102425104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker