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General NPI Number Information
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NPI Number | 1306438338
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Entity Type | Individual
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Provider Name | ALEXANDRIA MARIE GOBEN LCAT, ATR-BC
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Gender | Female
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 590 PRE EMPTION RD
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City | GENEVA
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State | NY
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Zip | 14456-1372
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Country | US
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Telephone | 315-209-4669
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Fax |
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Provider Business Mailing Address
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Address Line | 433 WILLIAM ST
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City | GENEVA
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State | NY
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Zip | 14456-2115
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Country | US
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Telephone | 315-521-7025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002067
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 002067
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License Number State | NY
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