Healthcare Provider Details

I. General information

NPI: 1215655378
Provider Name (Legal Business Name): EMMA GEBHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 WASHINGTON ST STE 3
JAMAICA PLAIN MA
02130-2691
US

IV. Provider business mailing address

3313 WASHINGTON ST STE 3
JAMAICA PLAIN MA
02130-2691
US

V. Phone/Fax

Practice location:
  • Phone: 617-237-7008
  • Fax:
Mailing address:
  • Phone: 617-237-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: