Kenneth W Gomez

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

1436 Issued in NC

Practice address

852 Merrimon Ave
Asheville, NC 28804-2405

Phone

(828) 251-6091

Fax

(828) 251-6911

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NC DHHS Child and Family Well-Being

  • Early Intervention Provider Agency
  • Asheville, NC
  • NPI 1942424387
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340236800000",
    "number": "1962523175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 MERRIMON AVE",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288042405",
            "telephone_number": "828-251-6091",
            "fax_number": "828-251-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 MERRIMON AVE",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288042405",
            "telephone_number": "828-251-6091",
            "fax_number": "828-251-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "KENNETH",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2012-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "1436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD",
            "identifier": "03400",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3403418",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul David Goll Jr., MSW LCSW
• Haley Grace Goller, PSY.D.
• Larry Golson, O.D.
• Natalie Kate Gomes, MA, LCMHCS, LCAS
• Ian Joseph Gomez, RD
• Kelly Gonzales
• Elide Gonzalez Perez, LCSWA
• Allyson Margaret Gonzalez
• Amy Lynn Gonzalez, LPN
• Daniel Gonzalez, L.AC.

• Clinical Child & Adolescent Psychologist in Asheville, NC
• Providers in Asheville, NC by specialty
• Clinical Child & Adolescent Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.