MEDICARE: DR. ELIZABETH GOSS PH.D.

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	103TC0700X	Clinical Psychologist	6301018396	MI

General Provider Information

NPI Number	:	1700208501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH GOSS PH.D.

Provider Business Mailing Address
First Line	:	220 W CONGRESS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-3289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W CONGRESS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-3289
Country	:	US
Telephone Number	:	734-584-0133
Fax Number	:

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

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	03/17/2025

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