Individual
MARIE GOULDSBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 E MONTAUK HWY, HAMPTON BAYS, NY 11946-1816
(631) 723-3362
Mailing address
16 FLORENCE DR, MANORVILLE, NY 11949-3008
(631) 478-7507
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
30619
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30619
OASAS CERTIFICATE
NY
Enumeration date
05/06/2016
Last updated
05/06/2016
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