Provider Demographics
NPI:1700997491
Name:BECK GOSS, JULIE (LICSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BECK GOSS
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 1:505 W HOLLIS ST
Mailing Address - Street 2:STE 210
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-880-1938
Mailing Address - Fax:603-880-1548
Practice Address - Street 1:505 W HOLLIS ST
Practice Address - Street 2:STE 210
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-880-1938
Practice Address - Fax:603-880-1548
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1671041C0700X
MA1066071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006879Medicaid
RE3191Medicare ID - Type Unspecified