MEDICARE: MICHELLE S GOULD MSW,LSW

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	104100000X	Social Worker	SW012116L	PA

General Provider Information

NPI Number	:	1558530774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE S GOULD MSW,LSW

Provider Business Mailing Address
First Line	:	582 SUNRISE DR
Second Line	:
City	:	LEECHBURG
State	:	PA
Zip	:	15656-1532
Country	:	US
Telephone Number	:	724-845-7155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S LEECHBURG HILL RD
Second Line	:
City	:	LEECHBURG
State	:	PA
Zip	:	15656-9502
Country	:	US
Telephone Number	:	724-845-2978
Fax Number	:

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

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/21/2008

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