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General NPI Number Information
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NPI Number | 1114070976
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Entity Type | Individual
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Provider Name | MARY ANNA GOURGOURAS MA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 27 HOLLIS ST
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City | FRAMINGHAM
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State | MA
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Zip | 01702-8615
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Country | US
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Telephone | 508-962-8641
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Fax | 508-481-1429
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Provider Business Mailing Address
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Address Line | 102 MORNINGSIDE RD
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City | WORCESTER
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State | MA
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Zip | 01602-2544
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Country | US
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Telephone | 508-756-7400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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