Provider Demographics
NPI:1902952435
Name:GOULD, MEREDITH ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:GOULD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053
Mailing Address - Country:US
Mailing Address - Phone:413-585-8643
Mailing Address - Fax:413-586-8329
Practice Address - Street 1:19 CENTER CT
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-6480
Practice Address - Fax:413-586-8329
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG0U50226Medicare ID - Type Unspecified