Healthcare Provider Details

I. General information

NPI: 1336648435
Provider Name (Legal Business Name): MRS. COURTNEY A GOUDREAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MERRIMACK ST STE 9
LAWRENCE MA
01843-1764
US

IV. Provider business mailing address

14 HERMON AVE
HAVERHILL MA
01832-3706
US

V. Phone/Fax

Practice location:
  • Phone: 978-688-4830
  • Fax:
Mailing address:
  • Phone: 978-994-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: