Provider Demographics
NPI:1265807994
Name:GOULD, LOIS JUNE (EI DS)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:JUNE
Last Name:GOULD
Suffix:
Gender:F
Credentials:EI DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 MILLBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2177
Mailing Address - Country:US
Mailing Address - Phone:508-755-1228
Mailing Address - Fax:508-797-3477
Practice Address - Street 1:237 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2177
Practice Address - Country:US
Practice Address - Phone:508-755-1228
Practice Address - Fax:508-797-3477
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163646174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042453851OtherTAX EXEMPT