Provider Demographics
NPI:1104577345
Name:GOLL, DARLENE E (LSW)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:E
Last Name:GOLL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1653
Mailing Address - Country:US
Mailing Address - Phone:617-320-3050
Mailing Address - Fax:
Practice Address - Street 1:49 FRONT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1653
Practice Address - Country:US
Practice Address - Phone:617-320-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty