Provider Demographics
NPI:1023563384
Name:GOFF, AMANDA (MT-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ORIOLE WAY
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2312
Mailing Address - Country:US
Mailing Address - Phone:508-423-1992
Mailing Address - Fax:
Practice Address - Street 1:64 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3812
Practice Address - Country:US
Practice Address - Phone:781-934-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11662225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist