Provider Demographics
NPI:1093862518
Name:GOSZ, PATRICIA DOROTHY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DOROTHY
Last Name:GOSZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 COHANSEY ST
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3962
Mailing Address - Country:US
Mailing Address - Phone:651-481-9113
Mailing Address - Fax:651-437-2012
Practice Address - Street 1:1200 18TH ST E
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3680
Practice Address - Country:US
Practice Address - Phone:651-438-8526
Practice Address - Fax:651-437-2012
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical