Provider Demographics
NPI:1225281553
Name:GAUVIN, JILLIAN MARIE
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:MARIE
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4632
Mailing Address - Country:US
Mailing Address - Phone:781-388-6283
Mailing Address - Fax:617-387-1089
Practice Address - Street 1:173 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-4632
Practice Address - Country:US
Practice Address - Phone:781-388-6283
Practice Address - Fax:617-387-1089
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health