Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0810003885 | VA |
Y | 103G00000X | Clinical Psychologist | 0810003885 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003885 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810003885 | VA |
NPI | 1184890204 |
---|---|
Provider Name | Dr. Peter Gould |
First Address | Fairfax, VA 22030-7501 |
Second Address | Fairfax, VA 22030-7501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 07/05/2010 |