Provider Demographics
NPI:1174288740
Name:GOULET, RACHEL E (PMHNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:GOULET
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:93 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6030
Practice Address - Country:US
Practice Address - Phone:207-777-8700
Practice Address - Fax:207-777-8826
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health