Provider Demographics
NPI:1245371913
Name:GOUZOUNIS, ALLYSON M (LICSW)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:M
Last Name:GOUZOUNIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01128-1245
Mailing Address - Country:US
Mailing Address - Phone:413-782-0281
Mailing Address - Fax:
Practice Address - Street 1:1942 PARKER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1245
Practice Address - Country:US
Practice Address - Phone:413-782-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical