Provider Demographics
NPI:1467903252
Name:GOULET, JASON RICHARD (MSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RICHARD
Last Name:GOULET
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HIGH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3053
Mailing Address - Country:US
Mailing Address - Phone:978-869-7201
Mailing Address - Fax:
Practice Address - Street 1:108 HIGH ST
Practice Address - Street 2:APT. 1
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3053
Practice Address - Country:US
Practice Address - Phone:978-869-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker