Provider Demographics
NPI:1386078335
Name:GOLD, R. ILISE (LPC)
Entity type:Individual
Prefix:MS
First Name:R.
Middle Name:ILISE
Last Name:GOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE TURKEY HILL ROAD SOUTH
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-222-9223
Mailing Address - Fax:203-221-7167
Practice Address - Street 1:ONE TURKEY HILL ROAD SOUTH
Practice Address - Street 2:SUITE D
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-222-9223
Practice Address - Fax:203-221-7167
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health