Provider Demographics
NPI:1528446671
Name:GOMEZ, AMILCAR B
Entity type:Individual
Prefix:
First Name:AMILCAR
Middle Name:B
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 COUNTRY CLUB DR
Mailing Address - Street 2:401
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3221
Mailing Address - Country:US
Mailing Address - Phone:754-307-3075
Mailing Address - Fax:305-412-0140
Practice Address - Street 1:7811 CORAL WAY
Practice Address - Street 2:106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:305-412-0138
Practice Address - Fax:305-412-0140
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-09
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH1049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health