Healthcare Provider Details

I. General information

NPI: 1629215751
Provider Name (Legal Business Name): ROBIN K GAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NEW LANCASTER ROAD
LEOMINSTER MA
01453-4958
US

IV. Provider business mailing address

5 NEPONSET ST FL STREET2
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0732
  • Fax: 508-425-5126
Mailing address:
  • Phone: 508-856-0732
  • Fax: 508-425-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number017404
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017404
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number017404
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number017404
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9844
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: