MEDICARE: MRS. COURTNEY A GOUDREAULT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1336648435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY A GOUDREAULT

Provider Business Mailing Address
First Line	:	14 HERMON AVE
Second Line	:
City	:	HAVERHILL
State	:	MA
Zip	:	01832-3706
Country	:	US
Telephone Number	:	978-994-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 MERRIMACK ST STE 9
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1764
Country	:	US
Telephone Number	:	978-688-4830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	05/13/2026

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