Provider Demographics
NPI:1114070976
Name:GOURGOURAS, MARY ANNA (MA)
Entity Type:Individual
Prefix:
First Name:MARY ANNA
Middle Name:
Last Name:GOURGOURAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARYANNA
Other - Middle Name:
Other - Last Name:DYMEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:102 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2544
Mailing Address - Country:US
Mailing Address - Phone:508-756-7400
Mailing Address - Fax:
Practice Address - Street 1:27 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8615
Practice Address - Country:US
Practice Address - Phone:508-962-8641
Practice Address - Fax:508-481-1429
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health