1922153741 NPI number — MS. DIANE ELIZABETH GOULD MSW, LICSW

Table of content: MS. DIANE ELIZABETH GOULD MSW, LICSW (NPI 1922153741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922153741 NPI number — MS. DIANE ELIZABETH GOULD MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULD
Provider First Name:
DIANE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922153741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 OFF SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01540-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-294-3093
Provider Business Mailing Address Fax Number:
508-861-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CLARKS HL
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-8172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-628-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 105822 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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