Provider Demographics
NPI:1700982220
Name:GOOCH, HIRAM GLENN JR (MSSW)
Entity Type:Individual
Prefix:MR
First Name:HIRAM
Middle Name:GLENN
Last Name:GOOCH
Suffix:JR
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 BERKELEY STATION RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-7040
Mailing Address - Country:US
Mailing Address - Phone:304-263-5531
Mailing Address - Fax:
Practice Address - Street 1:1101 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5941
Practice Address - Country:US
Practice Address - Phone:301-665-1462
Practice Address - Fax:301-665-1682
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCPE0938475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health