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: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5A WILSON ST
NATICK MA
01760-4796
US

IV. Provider business mailing address

5A WILSON ST
NATICK MA
01760-4796
US

V. Phone/Fax

Practice location:
  • Phone: 781-886-8028
  • Fax:
Mailing address:
  • Phone: 508-333-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number242835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: