Healthcare Provider Details

I. General information

NPI: 1225071350
Provider Name (Legal Business Name): LOIS E GOSS L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BRADFORD DR
SALEM NH
03079-2251
US

IV. Provider business mailing address

25 BRADFORD DR
SALEM NH
03079-2251
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-6829
  • Fax:
Mailing address:
  • Phone: 603-893-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number929
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number929
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number929
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: