Healthcare Provider Details

I. General information

NPI: 1972559045
Provider Name (Legal Business Name): SUZANNE T. GOSSELIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S HIRAM RD
HIRAM ME
04041-3636
US

IV. Provider business mailing address

14 GOSLING ROAD
SHAPLEIGH ME
04076
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-7134
  • Fax: 207-625-7186
Mailing address:
  • Phone: 207-793-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10742
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC10742
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: