Provider Demographics
NPI:1790310555
Name:LEAH BERKOWITZ-GOSSELIN
Entity Type:Organization
Organization Name:LEAH BERKOWITZ-GOSSELIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOWITZ-GOSSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-206-7692
Mailing Address - Street 1:PO BOX 1402
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-1402
Mailing Address - Country:US
Mailing Address - Phone:413-206-7692
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:24 N MAPLE ST STE 5
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1323
Practice Address - Country:US
Practice Address - Phone:413-206-7692
Practice Address - Fax:508-433-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty