Individual
ILSE M GOMEZ-AVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1450 WESTGATE DR, FORT LEE, NJ 07024-2171
(646) 246-7354
Mailing address
1450 WESTGATE DR, FORT LEE, NJ 07024-2171
(646) 246-7354
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
730818835
NY
Other
Enumeration date
04/15/2015
Last updated
04/15/2015
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