Provider Demographics
NPI:1013185701
Name:FALLON, GLORIA YUNCHUNG (PMHCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:YUNCHUNG
Last Name:FALLON
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:YUNCHUNG
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHCNS-BC
Mailing Address - Street 1:63 FOUNTAIN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6279
Mailing Address - Country:US
Mailing Address - Phone:508-872-4813
Mailing Address - Fax:508-626-0454
Practice Address - Street 1:63 FOUNTAIN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6279
Practice Address - Country:US
Practice Address - Phone:508-872-4813
Practice Address - Fax:508-626-0454
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242835163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health