Provider Demographics
NPI:1992860571
Name:GOMES, EDILIA F (PMHNP-BC, MSW)
Entity type:Individual
Prefix:
First Name:EDILIA
Middle Name:F
Last Name:GOMES
Suffix:
Gender:F
Credentials:PMHNP-BC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W FOSTER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3879
Mailing Address - Country:US
Mailing Address - Phone:781-824-6464
Mailing Address - Fax:
Practice Address - Street 1:1 W FOSTER ST STE 2
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3879
Practice Address - Country:US
Practice Address - Phone:781-824-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111096104100000X
MARN2270722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker