Provider Demographics
NPI:1033672225
Name:GOULDER, MARGARET RICCELLI
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:RICCELLI
Last Name:GOULDER
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 1:1000 SAN LEANDRO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1675
Mailing Address - Country:US
Mailing Address - Phone:650-804-5205
Mailing Address - Fax:
Practice Address - Street 1:1000 SAN LEANDRO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1675
Practice Address - Country:US
Practice Address - Phone:650-804-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical