Provider Demographics
NPI:1962783365
Name:GOMEZ, ESTHEPHANIA MERCEDEZ (MSW)
Entity type:Individual
Prefix:
First Name:ESTHEPHANIA
Middle Name:MERCEDEZ
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BERKELEY ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6230
Mailing Address - Country:US
Mailing Address - Phone:617-350-6900
Mailing Address - Fax:
Practice Address - Street 1:95 BERKELEY ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6230
Practice Address - Country:US
Practice Address - Phone:617-350-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical