Mary R. Gomez, LADAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Albuq, NM
NPI 1275974792 · NPPES record last updated Jul 12, 2013
Key facts
- NPI
- 1275974792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 3678 (NM)
- Practice address
- 1611 Central Ave. NW
Albuq, NM 87104 - Phone
- (505) 247-4622
- Fax
- (505) 247-1373
- NPI assigned
- Jul 12, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3678 | NM | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3678 | NM | Yes |
Addresses
Primary practice location
1611 Central Ave. NW
Albuq, NM 87104
Mailing address
1611 Central Ave NW
Albuquerque, NM 87104-1139
Phone (505) 247-4622
Other providers in Albuq, NM
All providers in Albuq, NM · Addiction (Substance Use Disorder) Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2013. 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.