Healthcare Provider Details

I. General information

NPI: 1174288740
Provider Name (Legal Business Name): RACHEL E GOULET PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL MORIARTY

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 CAMPUS AVE
LEWISTON ME
04240-6030
US

IV. Provider business mailing address

C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-8700
  • Fax: 207-777-8826
Mailing address:
  • Phone: 207-777-8950
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP211404
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: