Provider Demographics
NPI:1083683270
Name:PFEIFER, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PFEIFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4445
Mailing Address - Country:US
Mailing Address - Phone:617-277-8107
Mailing Address - Fax:
Practice Address - Street 1:43 GARRISON RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4445
Practice Address - Country:US
Practice Address - Phone:617-277-8107
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10533OtherBLUE CROSS BLUE SHIELD
MAW10533OtherBLUE CROSS BLUE SHIELD