Provider Demographics
NPI:1063631828
Name:HEARNS-ROGERS, GAYLE PATRICIA (LADC-1, CAS)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:PATRICIA
Last Name:HEARNS-ROGERS
Suffix:
Gender:F
Credentials:LADC-1, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-3050
Mailing Address - Country:US
Mailing Address - Phone:781-356-8017
Mailing Address - Fax:781-598-0210
Practice Address - Street 1:11 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-3050
Practice Address - Country:US
Practice Address - Phone:781-356-8017
Practice Address - Fax:781-598-0210
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)