Adam Goudreau, B.A., M.A.

Primary specialty

School PsychologistTaxonomy code 103TS0200X

Practice address

85 Philadelphia Ave
Massapequa Park, NY 11762-2547

Phone

(516) 626-1000

Fax

(516) 626-2039

NPI assigned

Sep 15, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts, Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1790067726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 PHILADELPHIA AVE",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117622547",
            "telephone_number": "516-626-1000",
            "fax_number": "516-626-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 PHILADELPHIA AVE",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117622547",
            "telephone_number": "516-626-1000",
            "fax_number": "516-626-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUDREAU",
        "first_name": "ADAM",
        "name_prefix": "Mr.",
        "credential": "B.A., M.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-15",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• School Psychologist in Massapequa Park, NY
• Providers in Massapequa Park, NY by specialty
• School Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.