Healthcare Provider Details

I. General information

NPI: 1124953054
Provider Name (Legal Business Name): LARA GAMA DE ALBUQUERQUE CAVALCANTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 WORCESTER RD
FRAMINGHAM MA
01701-5410
US

IV. Provider business mailing address

60 CHESTNUT ST APT 1
BROOKLINE MA
02445-7865
US

V. Phone/Fax

Practice location:
  • Phone: 508-628-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: