Provider Demographics
NPI:1083397707
Name:WINGATE, EMILY JOYCE
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JOYCE
Last Name:WINGATE
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 1:20 MOSSLAND ST # 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3207
Mailing Address - Country:US
Mailing Address - Phone:240-449-5688
Mailing Address - Fax:
Practice Address - Street 1:88 MONTVALE AVE
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3658
Practice Address - Country:US
Practice Address - Phone:240-449-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool