Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS928 | ME |
NPI | 1043320823 |
---|---|
Provider Name | Dr. Gail Goza-Macmullan |
First Address | North Yarmouth, ME 04097-6733 |
Second Address | Portland, ME 04101-2617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |