Provider Demographics
NPI:1386260040
Name:MUSICO, PHOEBE WARD GOULD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PHOEBE
Middle Name:WARD GOULD
Last Name:MUSICO
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 1:45 POPE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4328
Mailing Address - Country:US
Mailing Address - Phone:203-984-9352
Mailing Address - Fax:
Practice Address - Street 1:45 POPE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4328
Practice Address - Country:US
Practice Address - Phone:203-984-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical