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General NPI Number Information
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NPI Number | 1295155893
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Entity Type | Individual
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Provider Name | GERALD J GAURA JR. LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 10 DEPOT ST STE 100
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City | COLLINSVILLE
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State | CT
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Zip | 06019-4101
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Country | US
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Telephone | 860-323-3624
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Fax |
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Provider Business Mailing Address
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Address Line | 507 DOWD AVE
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City | CANTON
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State | CT
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Zip | 06019-2441
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Country | US
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Telephone | 860-451-9307
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Fax | 855-377-9142
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1666
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License Number State | CT
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