Provider Demographics
NPI:1942611942
Name:GOOCH, IRA (MA)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:GOOCH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1839
Mailing Address - Country:US
Mailing Address - Phone:207-939-3030
Mailing Address - Fax:
Practice Address - Street 1:181 UNION ST
Practice Address - Street 2:SUITE J
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-244-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health