Provider Demographics
NPI:1285913004
Name:GOLD, MARIEL EVE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIEL
Middle Name:EVE
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3005
Mailing Address - Country:US
Mailing Address - Phone:908-707-0212
Mailing Address - Fax:908-707-8498
Practice Address - Street 1:285 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-707-0212
Practice Address - Fax:908-707-8498
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL056417001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical