Provider Demographics
NPI:1225071350
Name:GOSS, LOIS E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:E
Last Name:GOSS
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 1:25 BRADFORD DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2251
Mailing Address - Country:US
Mailing Address - Phone:603-893-6829
Mailing Address - Fax:
Practice Address - Street 1:25 BRADFORD DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2251
Practice Address - Country:US
Practice Address - Phone:603-893-6829
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH929101Y00000X, 101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
14Y000861NH02OtherBLUE CROSS/BLUE SHIELD
NH30423938Medicaid
NH30423938Medicaid