Provider Demographics
NPI:1225245608
Name:GOULD, AILEEN ROBIN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:ROBIN
Last Name:GOULD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MCLOUGHLIN ST
Mailing Address - Street 2:APT. B
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1703
Mailing Address - Country:US
Mailing Address - Phone:516-759-0734
Mailing Address - Fax:516-759-0734
Practice Address - Street 1:21 MCLOUGHLIN ST
Practice Address - Street 2:APT. B
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1703
Practice Address - Country:US
Practice Address - Phone:516-759-0734
Practice Address - Fax:516-759-0734
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18002336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health