Provider Demographics
NPI:1184858631
Name:GANTES, PATRICIA CARRIE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CARRIE
Last Name:GANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXY
Other - Middle Name:
Other - Last Name:GANTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:227 BRIDGE ST. UNIT 3
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-695-9930
Mailing Address - Fax:
Practice Address - Street 1:227 BRIDGE ST UNIT 3
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2404
Practice Address - Country:US
Practice Address - Phone:413-695-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health