Provider Demographics
NPI:1801884465
Name:GOULD, MARTI (LICSW)
Entity type:Individual
Prefix:MISS
First Name:MARTI
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORTHEASTERN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3139
Mailing Address - Country:US
Mailing Address - Phone:603-546-5263
Mailing Address - Fax:603-886-8058
Practice Address - Street 1:11 NORTHEASTEN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3921
Practice Address - Country:US
Practice Address - Phone:603-546-5236
Practice Address - Fax:603-886-8058
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y007702NH02OtherBCBS
NH14Y007702NH03OtherBCBS