Healthcare Provider Details

I. General information

NPI: 1477091858
Provider Name (Legal Business Name): GAYLE CRAGIN M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 RICHARD RD
HINGHAM MA
02043-3926
US

IV. Provider business mailing address

19 RICHARD RD
HINGHAM MA
02043-3926
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-8596
  • Fax:
Mailing address:
  • Phone: 781-749-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number389194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: