Provider Demographics
NPI:1811236383
Name:GOMEZ, LIZETT (MSW)
Entity type:Individual
Prefix:
First Name:LIZETT
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LIZETT
Other - Middle Name:
Other - Last Name:GAONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2021 PEYTON AVE
Mailing Address - Street 2:209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3517
Mailing Address - Country:US
Mailing Address - Phone:626-664-8418
Mailing Address - Fax:
Practice Address - Street 1:547 S MARENGO AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3114
Practice Address - Country:US
Practice Address - Phone:800-488-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW34800101YM0800X, 104100000X
CAASW 348001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker