Active NPI
Donna Ann Goulette, LICENSED
- Social Worker
- Port Jervis, NY
National Provider Identifier
1487207189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 110544-01
- Practice address
- 146 Pike St
Port Jervis, NY 12771-1808 - Phone
- (845) 858-1456
- Fax
- (845) 858-1459
- NPI assigned
- Jul 22, 2019
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 110544-01 | NY | Primary |
Addresses
Primary practice location
146 Pike St
Port Jervis, NY 12771-1808
Mailing address
30 Harriman Dr
Goshen, NY 10924-2410
Phone (845) 291-2600
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110544-01 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651536000000",
"number": "1487207189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 HARRIMAN DR",
"city": "GOSHEN",
"state": "NY",
"postal_code": "109242410",
"telephone_number": "845-291-2600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 PIKE ST",
"city": "PORT JERVIS",
"state": "NY",
"postal_code": "127711808",
"telephone_number": "845-858-1456",
"fax_number": "845-858-1459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULETTE",
"first_name": "DONNA",
"middle_name": "ANN",
"credential": "LICENSED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-22",
"last_updated": "2022-05-03",
"certification_date": "2022-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "110544-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jervis, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.