Healthcare Provider Details

I. General information

NPI: 1013185701
Provider Name (Legal Business Name): GLORIA YUNCHUNG FALLON PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLORIA YUNCHUNG CHANG PMHCNS-BC

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FOUNTAIN ST SUITE 402
FRAMINGHAM MA
01702-6279
US

IV. Provider business mailing address

63 FOUNTAIN ST SUITE 402
FRAMINGHAM MA
01702-6279
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-4813
  • Fax: 508-626-0454
Mailing address:
  • Phone: 508-872-4813
  • Fax: 508-626-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number242835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: