Provider Demographics
NPI:1932801040
Name:GOMES, LAURA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:GOMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DORR DR
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-4427
Mailing Address - Country:US
Mailing Address - Phone:401-651-8839
Mailing Address - Fax:
Practice Address - Street 1:66 BURNETT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2527
Practice Address - Country:US
Practice Address - Phone:401-785-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW029351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical