Provider Demographics
NPI:1225156508
Name:GOULD, JAMES MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:GOULD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1909
Mailing Address - Country:US
Mailing Address - Phone:610-642-4421
Mailing Address - Fax:610-649-6133
Practice Address - Street 1:2743 MORRIS RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1909
Practice Address - Country:US
Practice Address - Phone:610-642-4421
Practice Address - Fax:610-649-6133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 005266L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPVR 110 R02Medicaid
PAR07065Medicare UPIN
PAGO 464153Medicare ID - Type Unspecified