Healthcare Provider Details

I. General information

NPI: 1427782911
Provider Name (Legal Business Name): SHAUNA GORHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ROCKLAND ST
WAKEFIELD MA
01880-2425
US

IV. Provider business mailing address

14 ROCKLAND ST
WAKEFIELD MA
01880-2425
US

V. Phone/Fax

Practice location:
  • Phone: 781-412-3803
  • Fax:
Mailing address:
  • Phone: 781-412-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: