Individual
BRIAN GONSALVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
248 HIGH ST, RANDOLPH, MA 02368-1837
(617) 407-4454
Mailing address
248 HIGH ST, RANDOLPH, MA 02368-1837
(617) 407-4454
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
115082
MA
101YP2500X
Professional Counselor
115082
MA
101YS0200X
School Counselor
—
—
104100000X
Social Worker
115082
MA
1041C0700X
Clinical Social Worker
Primary
115082
MA
Other
Enumeration date
05/21/2020
Last updated
06/05/2020
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