Provider Demographics
NPI:1750431938
Name:GOSNELL, DAVID WHITNEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WHITNEY
Last Name:GOSNELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FORSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944
Mailing Address - Country:US
Mailing Address - Phone:978-526-7101
Mailing Address - Fax:
Practice Address - Street 1:5 ESSEX GREEN DRIVE
Practice Address - Street 2:SUITE 22
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-531-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W04988Medicare ID - Type Unspecified