Healthcare Provider Details

I. General information

NPI: 1275191199
Provider Name (Legal Business Name): ANNKATRINE GATES PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COOLIDGE HILL ROAD
CAMBRIDGE MA
02138-5510
US

IV. Provider business mailing address

10 COOLIDGE HILL ROAD
CAMBRIDGE MA
02138-5510
US

V. Phone/Fax

Practice location:
  • Phone: 617-800-9469
  • Fax:
Mailing address:
  • Phone: 617-800-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNKATRINE LIEGMANN GATES
Title or Position: MANGER/OWNER
Credential: PSYD
Phone: 617-800-9469