Provider Demographics
NPI:1194958793
Name:GOUFFRANT, CECILE
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:GOUFFRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CECILE
Other - Middle Name:GOUFFRANT
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 WILLIAM ST
Mailing Address - Street 2:APT 511
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1503
Practice Address - Country:US
Practice Address - Phone:510-501-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program