Provider Demographics
NPI:1205846599
Name:GORVIN, JOHN J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:GORVIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LINCOLN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3021
Mailing Address - Country:US
Mailing Address - Phone:781-246-4555
Mailing Address - Fax:
Practice Address - Street 1:7 LINCOLN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3021
Practice Address - Country:US
Practice Address - Phone:781-246-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1041330OtherBEACON HEALTH
NY102732OtherEMPIRE BLUE CROSS
MA012426OtherVALUE OPTIONS
MA0526649Medicaid
MA1899384OtherMBHP
MAW05072OtherBLUE CROSS
MA012426OtherVALUE OPTIONS