Provider Demographics
NPI:1790067726
Name:GOUDREAU, ADAM (BA, MA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:GOUDREAU
Suffix:
Gender:M
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2547
Mailing Address - Country:US
Mailing Address - Phone:516-626-1000
Mailing Address - Fax:516-626-2039
Practice Address - Street 1:85 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2547
Practice Address - Country:US
Practice Address - Phone:516-626-1000
Practice Address - Fax:516-626-2039
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool