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General NPI Number Information
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NPI Number | 1639251093
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Entity Type | Individual
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Provider Name | RAVI GATHA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 41 GARRISON RD
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City | BROOKLINE
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State | MA
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Zip | 02445-4445
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Country | US
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Telephone | 617-383-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 197 PINE GROVE ST
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City | NEEDHAM
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State | MA
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Zip | 02494-1735
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Country | US
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Telephone | 617-383-4025
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 9251
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 9251
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License Number State | MA
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