Provider Demographics
NPI:1871008433
Name:GOSS, CLAIRE MAURENN
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MAURENN
Last Name:GOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 DA VINCI DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:650-269-5888
Mailing Address - Fax:
Practice Address - Street 1:5406 DA VINCI DRIVE
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:650-269-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
EZ1287103TS0200X
CAEZ1287103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool