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NPI Code Detail

MEDICARE: JOAN B GAY LICSW

MEDICARE: JOAN B GAY 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 Worker100378MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100378OTHERMASOCIAL WORK LICENSE

General Provider Information

NPI Number : 1558499210
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOAN B GAY LICSW
Provider Business Mailing Address
First Line : 25 LACLEDE AVE
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01701-4248
Country : US
Telephone Number : 508-877-3824
Fax Number :
Provider Business Practice Location Address
First Line : 10 LONGWOOD DR
Second Line :
City : WESTWOOD
State : MA
Zip : 02090-1123
Country : US
Telephone Number : 781-493-6815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 07/08/2007

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