Provider Demographics
NPI:1225409253
Name:AMY GOFFREDO LLC
Entity Type:Organization
Organization Name:AMY GOFFREDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GOFFREDO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-313-2082
Mailing Address - Street 1:77 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1013
Mailing Address - Country:US
Mailing Address - Phone:508-313-2082
Mailing Address - Fax:508-313-2082
Practice Address - Street 1:1342 BELMONT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4436
Practice Address - Country:US
Practice Address - Phone:508-313-2082
Practice Address - Fax:508-313-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1174651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty