Provider Demographics
NPI:1043776743
Name:GAW, MAILING
Entity Type:Individual
Prefix:
First Name:MAILING
Middle Name:
Last Name:GAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1707
Mailing Address - Country:US
Mailing Address - Phone:617-851-6816
Mailing Address - Fax:
Practice Address - Street 1:44 ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1707
Practice Address - Country:US
Practice Address - Phone:617-851-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency