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General NPI Number Information
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NPI Number | 1639568751
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Entity Type | Individual
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Provider Name | CAROL JANE GAMMELL M.ED., M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 140 GLASTONBURY BOULEVARD, SUITE 30
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-878-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 140 GLASTONBURY BOULEVARD, SUITE 30
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-878-4920
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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 | 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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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 000426
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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