Active NPI
Danielle Gofman, MA, LPC, C-DBT
- Mental Health Counselor
- Bridgeport, CT
National Provider Identifier
1437760071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 004431
- Practice address
- 2675 Park Ave Unit 29
Bridgeport, CT 06604-1356 - Phone
- (724) 601-7222
- NPI assigned
- Aug 16, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 004431 | CT | Primary |
Addresses
Primary practice location
2675 Park Ave Unit 29
Bridgeport, CT 06604-1356
Mailing address
2675 Park Ave Unit 29
Bridgeport, CT 06604-1356
Phone (724) 601-7222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004431 | CT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish the Heart Counseling | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597536000000",
"number": "1437760071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2675 PARK AVE UNIT 29",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066041356",
"telephone_number": "724-601-7222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2675 PARK AVE UNIT 29",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066041356",
"telephone_number": "724-601-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOFMAN",
"first_name": "DANIELLE",
"credential": "MA, LPC, C-DBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-16",
"last_updated": "2020-08-16",
"certification_date": "2020-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CT",
"license": "004431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.