=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861638801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUISA GOULD LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2008
-----------------------------------------------------
Last Update Date | 08/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 NATHAN ELLIS HWY STE B
-----------------------------------------------------
City | MASHPEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02649-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-255-0635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 56
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02541-0056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-255-0635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 119461
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------