Healthcare Provider Details

I. General information

NPI: 1972598381
Provider Name (Legal Business Name): MITCHELL DAVID GURK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HASTINGS RD
SPENCER MA
01562-1408
US

IV. Provider business mailing address

16 HASTINGS RD
SPENCER MA
01562-1408
US

V. Phone/Fax

Practice location:
  • Phone: 508-885-3861
  • Fax:
Mailing address:
  • Phone: 508-885-3861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMAPY2497
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMAMFT807
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: