Provider Demographics
NPI:1023593605
Name:GOOD, GAIL BARAN (MSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:BARAN
Last Name:GOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13896 COVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2449
Mailing Address - Country:US
Mailing Address - Phone:248-420-9439
Mailing Address - Fax:
Practice Address - Street 1:13896 COVINGTON DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2449
Practice Address - Country:US
Practice Address - Phone:248-420-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019438-SW-LICSW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health