Provider Demographics
NPI:1417295791
Name:GOLD, SARAH JANE (LMHC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:GOLD
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 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2331
Mailing Address - Country:US
Mailing Address - Phone:312-213-4643
Mailing Address - Fax:
Practice Address - Street 1:66 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1737
Practice Address - Country:US
Practice Address - Phone:781-631-8273
Practice Address - Fax:781-631-7264
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health