Provider Demographics
NPI:1689850174
Name:GOSCINSKI, JENNIFER HUDSON (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HUDSON
Last Name:GOSCINSKI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-0268
Mailing Address - Country:US
Mailing Address - Phone:252-489-9127
Mailing Address - Fax:252-480-3127
Practice Address - Street 1:7531 S VIRGINIA DARE TRL
Practice Address - Street 2:SUITE 3A
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9162
Practice Address - Country:US
Practice Address - Phone:252-489-9127
Practice Address - Fax:252-480-3127
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0059151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106866Medicaid