Healthcare Provider Details

I. General information

NPI: 1144414087
Provider Name (Legal Business Name): NATHAN MICHAEL GAY MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BELMONT ST
WORCESTER MA
01604-1675
US

IV. Provider business mailing address

509 PLANTATION ST APT 115
WORCESTER MA
01605-4338
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-3261
  • Fax:
Mailing address:
  • Phone: 812-236-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: