Provider Demographics
NPI:1184649840
Name:GOOLEY, WILLIAM P (LICSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:GOOLEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3012
Mailing Address - Country:US
Mailing Address - Phone:508-845-7463
Mailing Address - Fax:
Practice Address - Street 1:13 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2637
Practice Address - Country:US
Practice Address - Phone:508-798-6699
Practice Address - Fax:508-798-7011
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10241701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA800012720OtherRAIL ROAD MEDICARE
MA62-00270OtherEVERCARE
MAP22578Medicare ID - Type Unspecified