Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 7705 | MA |
NPI | 1093212615 |
---|---|
Provider Name | Julie Gold |
First Address | Brookline, MA 02445-5308 |
Second Address | Brookline, MA 02445-5308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |