Provider Demographics
NPI:1699795013
Name:GOULD, JAY GALBRAITH JR (PH D)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:GALBRAITH
Last Name:GOULD
Suffix:JR
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SALEM WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1136
Mailing Address - Country:US
Mailing Address - Phone:516-759-1979
Mailing Address - Fax:516-759-1979
Practice Address - Street 1:11021 73RD ROAD
Practice Address - Street 2:1J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:516-759-1979
Practice Address - Fax:516-759-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006296103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist