Healthcare Provider Details

I. General information

NPI: 1306332986
Provider Name (Legal Business Name): JAY GOULD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HOWARD ST STE 300
BALTIMORE MD
21218-5909
US

IV. Provider business mailing address

3029 OAK COVE DR
CLEARWATER FL
33759-1318
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-6742
  • Fax: 443-773-5624
Mailing address:
  • Phone: 315-317-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC10626
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP8768
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: