Provider Demographics
NPI:1023151099
Name:GOSSMAN, DAVID PAUL (MED)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:GOSSMAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JEFFERY LANE
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007
Mailing Address - Country:US
Mailing Address - Phone:603-357-5270
Mailing Address - Fax:603-357-6875
Practice Address - Street 1:6 JEFFERY LN
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9413
Practice Address - Country:US
Practice Address - Phone:603-283-1614
Practice Address - Fax:603-357-6875
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH101Y00000XOtherUNLICENSED COUNSELOR