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NPI Code Detail

MEDICARE: JO-ANNE GAUGHAN-CABRAL LICSW

MEDICARE:   JO-ANNE  GAUGHAN-CABRAL  LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCT
21041C0700XClinical Social Worker107526MA

General Provider Information

NPI Number : 1306881651
Entity Type Code : Individual
Provider Name (Legal Business Name) : JO-ANNE GAUGHAN-CABRAL LICSW
Provider Business Mailing Address
First Line : 5 WELLINGTON CIR
Second Line :
City : EASTHAMPTON
State : MA
Zip : 01027-2543
Country : US
Telephone Number : 413-529-0325
Fax Number :
Provider Business Practice Location Address
First Line : 1132 WESTFIELD ST
Second Line :
City : WEST SPRINGFIELD
State : MA
Zip : 01089-3878
Country : US
Telephone Number : 413-592-1980
Fax Number : 413-439-0096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 07/08/2007

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