Provider Demographics
NPI:1629622329
Name:GOOLSARRAN, MERISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:
Last Name:GOOLSARRAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PLYMOUTH SORRENTO RD UNIT 651
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:FL
Mailing Address - Zip Code:32768-6428
Mailing Address - Country:US
Mailing Address - Phone:386-227-7192
Mailing Address - Fax:
Practice Address - Street 1:900 PLYMOUTH SORRENTO RD UNIT 651
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:FL
Practice Address - Zip Code:32768-6428
Practice Address - Country:US
Practice Address - Phone:386-227-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW118521041C0700X
FLSW176301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical