MEDICARE: MR. MARK HOWARD GOFSTEIN LMHC

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	101YM0800X	Mental Health Counselor	1110	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1M1221	OTHER	MA	BLUE CROSSBLUESHIELD

General Provider Information

NPI Number	:	1588733927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK HOWARD GOFSTEIN LMHC

Provider Business Mailing Address
First Line	:	111 EVERETT AVE
Second Line	:	SUITE 2B
City	:	CHELSEA
State	:	MA
Zip	:	02150-2385
Country	:	US
Telephone Number	:	617-889-1545
Fax Number	:	617-889-1545

Provider Business Practice Location Address
First Line	:	111 EVERETT AVE
Second Line	:	SUITE 2B
City	:	CHELSEA
State	:	MA
Zip	:	02150-2385
Country	:	US
Telephone Number	:	617-889-1545
Fax Number	:	617-889-1545

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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