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NPI Code Detail

MEDICARE: DR. CARIE GAVIGAN PH.D.

MEDICARE: DR. CARIE GAVIGAN 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
1103TC0700XClinical Psychologist8059MA

General Provider Information

NPI Number : 1558310631
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARIE GAVIGAN PH.D.
Provider Business Mailing Address
First Line : 82 MARLBOROUGH ST
Second Line :
City : BOSTON
State : MA
Zip : 02116-2020
Country : US
Telephone Number : 617-247-3457
Fax Number :
Provider Business Practice Location Address
First Line : 82 MARLBOROUGH ST
Second Line :
City : BOSTON
State : MA
Zip : 02116-2020
Country : US
Telephone Number : 617-247-3457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CARIE GAVIGAN PH.D.” Practice Location

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