Provider Demographics
NPI:1093428492
Name:GOMES, LAWRENCE EUGENE II (DIRECT CARE WORKER)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:GOMES
Suffix:II
Gender:M
Credentials:DIRECT CARE WORKER
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:EUGENE
Other - Last Name:GOMES
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:DIRECT CARE WORKER
Mailing Address - Street 1:10933 W COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4322
Mailing Address - Country:US
Mailing Address - Phone:602-616-0723
Mailing Address - Fax:
Practice Address - Street 1:10933 W COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4322
Practice Address - Country:US
Practice Address - Phone:602-616-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNA3747A0650X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty