Healthcare Provider Details

I. General information

NPI: 1245288497
Provider Name (Legal Business Name): NADJA B GOULD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MT AUBURN ST
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

36 ADAMS AVENUE
WATERTOWN MA
02472
US

V. Phone/Fax

Practice location:
  • Phone: 617-924-4438
  • Fax:
Mailing address:
  • Phone: 617-924-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: