Provider Demographics
NPI:1033009238
Name:GOMEZ, IVAN MAURICIO
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:MAURICIO
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 1:5 TOWN BEACH RD APT 41
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1944
Mailing Address - Country:US
Mailing Address - Phone:508-395-2232
Mailing Address - Fax:508-395-2232
Practice Address - Street 1:5 TOWN BEACH RD APT 41
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1944
Practice Address - Country:US
Practice Address - Phone:508-395-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor