Healthcare Provider Details

I. General information

NPI: 1508212903
Provider Name (Legal Business Name): KAJAL GEHI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MERRIMAC ST
WOBURN MA
01801-1641
US

IV. Provider business mailing address

34 MERRIMAC ST
WOBURN MA
01801-1641
US

V. Phone/Fax

Practice location:
  • Phone: 646-246-9276
  • Fax:
Mailing address:
  • Phone: 646-246-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080626
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121487
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: