Gosha Donnelly, PH.D.

Key facts

NPI

1760416101

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Psychologist 103TC0700X

License

0480000708 (VT)

Practice address

11 Beaver Meadow Road
Suite 4, Office 2
Norwich, VT 05055

Phone

(802) 649-2266

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Philosophy

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760416101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BEAVER MEADOW ROAD",
            "address_2": "SUITE 4, OFFICE 2",
            "city": "NORWICH",
            "state": "VT",
            "postal_code": "05055",
            "telephone_number": "802-649-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 BEAVER MEADOW ROAD",
            "address_2": "SUITE 4, OFFICE 2",
            "city": "NORWICH",
            "state": "VT",
            "postal_code": "05055",
            "telephone_number": "802-649-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "GOSHA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "0480000708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN 1837",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Norwich, VT · Clinical Psychologist in Vermont