Provider Demographics
NPI:1730660648
Name:GOSNELL, ASA ANDREW
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:ANDREW
Last Name:GOSNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CENTENNIAL DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7940
Mailing Address - Country:US
Mailing Address - Phone:978-927-9410
Mailing Address - Fax:978-531-1355
Practice Address - Street 1:9 CENTENNIAL DR UNIT 202
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7940
Practice Address - Country:US
Practice Address - Phone:978-927-9410
Practice Address - Fax:978-531-1355
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst