Brian Jesse Gomez
Individual provider Active NPI Behavior Technician · Lyons, IL
NPI 1093214520 · NPPES record last updated Feb 10, 2018
Key facts
- NPI
- 1093214520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 4220 Fishermans Ter
Lyons, IL 60534-1402 - Phone
- (708) 612-2756
- NPI assigned
- Feb 10, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
4220 Fishermans Ter
Lyons, IL 60534-1402
Mailing address
4220 Fishermans Ter
Lyons, IL 60534-1402
Other providers in Lyons, IL
- Sarah Haixin Feng
- Florecemos Therapy, PLLC
- Lauren Darlene Frigo
- Rosemary Elizabeth Gahl
- Jeremy Glavanovits
- Christopher Leon Grunow
- Sammy I Hakky
- Kellie Halvey
- Saja Hamad
- Farah Hamada
All providers in Lyons, IL · Behavior Technician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.