Provider Demographics
NPI:1548308224
Name:GOLD, ALAN (LICSW)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GOLD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TREMONT ST
Mailing Address - Street 2:#711
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-5013
Mailing Address - Country:US
Mailing Address - Phone:617-482-8770
Mailing Address - Fax:617-482-8770
Practice Address - Street 1:101 TREMONT ST
Practice Address - Street 2:#711
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-5013
Practice Address - Country:US
Practice Address - Phone:617-482-8770
Practice Address - Fax:617-482-8770
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08210OtherBCBS
MAP08210OtherBCBS