Provider Demographics
NPI:1023551660
Name:GOUSSE, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:GOUSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14880 SW 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6275
Mailing Address - Country:US
Mailing Address - Phone:786-318-8732
Mailing Address - Fax:
Practice Address - Street 1:14880 SW 180TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-6275
Practice Address - Country:US
Practice Address - Phone:786-318-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health