Provider Demographics
NPI:1598457558
Name:GOULD, LILY
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEO
Other - Middle Name:
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:206 CHESTNUT HILL AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4605
Mailing Address - Country:US
Mailing Address - Phone:518-729-6549
Mailing Address - Fax:
Practice Address - Street 1:206 CHESTNUT HILL AVE APT 9
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-4605
Practice Address - Country:US
Practice Address - Phone:518-729-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician