Healthcare Provider Details

I. General information

NPI: 1679273809
Provider Name (Legal Business Name): LAUREN JANSEN GOUVEIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E HARTLAND RD
BARKHAMSTED CT
06063-1147
US

IV. Provider business mailing address

219 E HARTLAND RD
BARKHAMSTED CT
06063-1147
US

V. Phone/Fax

Practice location:
  • Phone: 508-562-2620
  • Fax:
Mailing address:
  • Phone: 150-856-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006949
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: