Provider Demographics
NPI:1093289670
Name:GOSS, DANA TARESE (MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:TARESE
Last Name:GOSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4521
Mailing Address - Country:US
Mailing Address - Phone:973-951-8024
Mailing Address - Fax:
Practice Address - Street 1:1432 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4521
Practice Address - Country:US
Practice Address - Phone:973-951-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst