Provider Demographics
NPI:1326195868
Name:GOFSEYEFF, MIRIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:GOFSEYEFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 LINDSAY POND RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-5217
Mailing Address - Country:US
Mailing Address - Phone:978-369-7253
Mailing Address - Fax:
Practice Address - Street 1:389 LINDSAY POND RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-5217
Practice Address - Country:US
Practice Address - Phone:978-369-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY1218103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist