Provider Demographics
NPI:1235440868
Name:GOULD, KAREN (LMHC, CASAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3584
Mailing Address - Country:US
Mailing Address - Phone:585-944-9563
Mailing Address - Fax:
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3503
Practice Address - Country:US
Practice Address - Phone:585-944-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21754101YA0400X
NY004518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)