Healthcare Provider Details

I. General information

NPI: 1043320823
Provider Name (Legal Business Name): GAIL GOZA-MACMULLAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 WASHINGTON AVE
PORTLAND ME
04101-2617
US

IV. Provider business mailing address

110 CHRISTOPHER RD
NORTH YARMOUTH ME
04097-6733
US

V. Phone/Fax

Practice location:
  • Phone: 207-771-3553
  • Fax: 781-687-3470
Mailing address:
  • Phone: 207-771-3553
  • Fax: 781-687-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS928
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: