1033370507 NPI number — MS. KATHLEEN MAY GOFORTH LICSW

Table of content: MS. KATHLEEN MAY GOFORTH LICSW (NPI 1033370507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033370507 NPI number — MS. KATHLEEN MAY GOFORTH LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOFORTH
Provider First Name:
KATHLEEN
Provider Middle Name:
MAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033370507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 BERKELEY ST FL 6
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02116-6230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-778-1175
Provider Business Mailing Address Fax Number:
617-350-6901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 BERKELEY ST FL 6
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02116-6230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-778-1175
Provider Business Practice Location Address Fax Number:
617-350-6901
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  114631 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com