MEDICARE: DR. GAYLE JEANNETTE SECORD PH.D.

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
1	103G00000X	Clinical Neuropsychologist	4715 PR	MA
2	103TA0700X	Adult Development & Aging Psychologist	4715 PR	MA
3	103TB0200X	Cognitive & Behavioral Psychologist	4715 PR	MA
4	103TC0700X	Clinical Psychologist	4715 PR	MA
5	103TC2200X	Clinical Child & Adolescent Psychologist	4715 PR	MA
6	103TE1100X	Exercise & Sports Psychologist	4715 PR	MA
7	103TF0000X	Family Psychologist	4715 PR	MA
8	103TH0004X	Health Psychologist	4715 PR	MA

General Provider Information

NPI Number	:	1356462113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE JEANNETTE SECORD PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 2522
Second Line	:
City	:	WESTWOOD
State	:	MA
Zip	:	02090-7522
Country	:	US
Telephone Number	:	781-329-1891
Fax Number	:	781-762-0739

Provider Business Practice Location Address
First Line	:	15 COTTAGE ST
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-2153
Country	:	US
Telephone Number	:	781-329-1891
Fax Number	:	781-762-0739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	11/29/2012

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