Individual
MS. PRISCILLA M GOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LADC, CCS
Contact information
Practice address
25 HUDSON ST, BANGOR, ME 04401
(207) 947-3594
(207) 947-7108
Mailing address
25 HUDSON ST, BANGOR, ME 04401
(207) 947-3594
(207) 947-7108
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC4072
ME
174400000X
Specialist
LC750
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424240099
—
ME
01
—
ME7503
MEDICARE PTAN
ME
Enumeration date
07/21/2006
Last updated
01/06/2016
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