Individual
DR. MICHAEL DANIEL GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1011 VETERANS MEMORIAL PKWY, RIVERSIDE, RI 02915-5061
(401) 432-1000
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1156
OK
103TC0700X
Clinical Psychologist
TLMLP1139
KS
103TC2200X
Clinical Child & Adolescent Psychologist
37162
TX
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS01997
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841281805
—
KS
Enumeration date
12/27/2007
Last updated
09/28/2021
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