Provider Demographics
NPI:1235522970
Name:GYAN, SONIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:GYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BAKER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2131
Mailing Address - Country:US
Mailing Address - Phone:978-202-5636
Mailing Address - Fax:978-267-6525
Practice Address - Street 1:300 BAKER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2131
Practice Address - Country:US
Practice Address - Phone:978-202-5636
Practice Address - Fax:978-267-6525
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X, 103TB0200X, 103TH0004X
MA6998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth