Healthcare Provider Details

I. General information

NPI: 1336089606
Provider Name (Legal Business Name): GORDON G WACHIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST
LAWRENCE MA
01840-1866
US

IV. Provider business mailing address

35 ROBBINS AVE UNIT 19
DRACUT MA
01826-5270
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-7289
  • Fax: 978-686-2954
Mailing address:
  • Phone: 978-608-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: