Provider Demographics
NPI:1437470192
Name:GOSMANN, UTA
Entity Type:Individual
Prefix:
First Name:UTA
Middle Name:
Last Name:GOSMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ACADEMY ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6972
Mailing Address - Country:US
Mailing Address - Phone:203-804-7715
Mailing Address - Fax:
Practice Address - Street 1:42 ACADEMY ST
Practice Address - Street 2:APT. 5
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6972
Practice Address - Country:US
Practice Address - Phone:203-804-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health