Provider Demographics
NPI:1669519955
Name:GOULD, BEVERLY CONSTANCE (LCSW, PSYD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:CONSTANCE
Last Name:GOULD
Suffix:
Gender:F
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:401 8TH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3604
Mailing Address - Country:US
Mailing Address - Phone:718-297-8000
Mailing Address - Fax:718-262-8228
Practice Address - Street 1:8956 162ND ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5072
Practice Address - Country:US
Practice Address - Phone:718-297-8000
Practice Address - Fax:718-262-8228
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075295-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical