Individual
JACOB A GOYCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17 HOSPITAL DR, MASSENA, NY 13662-1093
(315) 705-6564
Mailing address
17 HOSPITAL DR, MASSENA, NY 13662-1093
(315) 705-6564
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141536222
WORK
NY
Enumeration date
07/07/2022
Last updated
07/07/2022
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