Provider Demographics
NPI:1588733927
Name:GOFSTEIN, MARK HOWARD (LMHC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:HOWARD
Last Name:GOFSTEIN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 EVERETT AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2385
Mailing Address - Country:US
Mailing Address - Phone:617-889-1545
Mailing Address - Fax:617-889-1545
Practice Address - Street 1:111 EVERETT AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2385
Practice Address - Country:US
Practice Address - Phone:617-889-1545
Practice Address - Fax:617-889-1545
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1M1221OtherBLUE CROSSBLUESHIELD