Healthcare Provider Details

I. General information

NPI: 1780759613
Provider Name (Legal Business Name): LAURA M. GAUGH (PSYD)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST CAMBRIDGE HEALTH ALLIANCE, STATION LANDING/CCAD
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

CAMBRIDGE HEALTH ALLIANCE STATION LANDING/CCAD 1493 CAMBRIDGE STREET
CAMBRIDGE MA
02139
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-8656
  • Fax:
Mailing address:
  • Phone: 781-306-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8904
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number8904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: