MEDICARE: JULIANA GOFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1558169698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA GOFF

Provider Business Mailing Address
First Line	:	146 WATERMAN LAKE DR
Second Line	:
City	:	CHEPACHET
State	:	RI
Zip	:	02814-2316
Country	:	US
Telephone Number	:	401-256-3281
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 FLEMING RD
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-3057
Country	:	US
Telephone Number	:	401-462-4047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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