Provider Demographics
NPI:1427770890
Name:GOMEZ, YELIDA
Entity type:Individual
Prefix:
First Name:YELIDA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 E EVERGREEN DR APT 102
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-8723
Mailing Address - Country:US
Mailing Address - Phone:646-706-3227
Mailing Address - Fax:
Practice Address - Street 1:721 S QUENTIN RD STE 103
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6778
Practice Address - Country:US
Practice Address - Phone:847-359-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health