Provider Demographics
NPI:1588652945
Name:GOULD, GEORGINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:GEORGINA
Middle Name:
Last Name:GOULD
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:VIA VIAL DI ROMANS, 81
Mailing Address - Street 2:
Mailing Address - City:CORDENONS
Mailing Address - State:ITALY
Mailing Address - Zip Code:33084
Mailing Address - Country:IT
Mailing Address - Phone:39043-458-1056
Mailing Address - Fax:
Practice Address - Street 1:AVIANO HS
Practice Address - Street 2:UNIT 6219, BOX 180
Practice Address - City:AVIANO
Practice Address - State:ITALY
Practice Address - Zip Code:09604
Practice Address - Country:IT
Practice Address - Phone:39043-430-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW21444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW21444OtherSTATE LICENSURE