Provider Demographics
NPI:1124563879
Name:PASCALE GOUSSELAND, PH.D
Entity Type:Organization
Organization Name:PASCALE GOUSSELAND, PH.D
Other - Org Name:PASCALE GOUSSELAND, PH.D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST/PSYCHOANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:PASCALE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOUSSELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-472-6881
Mailing Address - Street 1:117 EAST 71ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4383
Mailing Address - Country:US
Mailing Address - Phone:212-472-6881
Mailing Address - Fax:
Practice Address - Street 1:117 E 71ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4215
Practice Address - Country:US
Practice Address - Phone:212-472-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000842305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service