Healthcare Provider Details

I. General information

NPI: 1194958793
Provider Name (Legal Business Name): CECILE GOUFFRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECILE GOUFFRANT MCKENNA

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 01/22/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S 16TH ST
PHILADELPHIA PA
19146-1503
US

IV. Provider business mailing address

600 WILLIAM ST APT 511
OAKLAND CA
94612-1081
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-7632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: