Provider Demographics
NPI:1407045941
Name:GOUDREAU, JAMIE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:GOUDREAU
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 1:500 CUMMINGS CTR
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6142
Mailing Address - Country:US
Mailing Address - Phone:617-320-0068
Mailing Address - Fax:
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:SUITE 1100
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6142
Practice Address - Country:US
Practice Address - Phone:617-320-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool