Provider Demographics
NPI:1114041597
Name:TOWN OF GLOUCESTER
Entity Type:Organization
Organization Name:TOWN OF GLOUCESTER
Other - Org Name:GLOUCESTER PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-281-9804
Mailing Address - Street 1:6 SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 SCHOOL HOUSE RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2702
Practice Address - Country:US
Practice Address - Phone:978-281-9804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951068Medicaid