Provider Demographics
NPI:1235270943
Name:JOSLOW, GARY D (MED, PHD CAND)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:JOSLOW
Suffix:
Gender:M
Credentials:MED, PHD CAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1622
Mailing Address - Country:US
Mailing Address - Phone:781-799-0025
Mailing Address - Fax:617-523-1207
Practice Address - Street 1:18 DIAMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1622
Practice Address - Country:US
Practice Address - Phone:781-799-0025
Practice Address - Fax:617-523-1207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1612103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical