Healthcare Provider Details

I. General information

NPI: 1417914391
Provider Name (Legal Business Name): GARY SINCLAIR LCSW, CADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAIN ST SECOND FLOOR
TOPSFIELD MA
01983-1803
US

IV. Provider business mailing address

5 HARRISON EATON LN
AMESBURY MA
01913-5314
US

V. Phone/Fax

Practice location:
  • Phone: 978-887-6512
  • Fax:
Mailing address:
  • Phone: 978-337-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number201105
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: