Provider Demographics
NPI:1114143526
Name:CORRIGAN, GAIL (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COOLIDGE AVE
Mailing Address - Street 2:211
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2881
Mailing Address - Country:US
Mailing Address - Phone:617-924-4454
Mailing Address - Fax:617-926-4454
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:109
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:617-924-4430
Practice Address - Fax:617-926-4454
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1010681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid
MAP21976Medicare ID - Type UnspecifiedMEDICARE
MA1303414Medicaid