Provider Demographics
NPI:1952810004
Name:GOULD, JEANNETTE DANIELLE (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:DANIELLE
Last Name:GOULD
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:DANIELLE
Other - Last Name:MUNAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2902 WINDSOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2360
Mailing Address - Country:US
Mailing Address - Phone:857-919-2221
Mailing Address - Fax:
Practice Address - Street 1:2902 WINDSOR RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2360
Practice Address - Country:US
Practice Address - Phone:857-919-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst