Provider Demographics
NPI:1497011365
Name:GOULD, EVELYN (PHD BCBA-D)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:PHD BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 S SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-3411
Mailing Address - Country:US
Mailing Address - Phone:818-255-8108
Mailing Address - Fax:
Practice Address - Street 1:10 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2322
Practice Address - Country:US
Practice Address - Phone:781-462-6988
Practice Address - Fax:833-756-5677
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2122103K00000X
CA31701103TC2200X
1-10-6855103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst