Provider Demographics
NPI:1275191199
Name:ANNKATRINE GATES PSYD PLLC
Entity Type:Organization
Organization Name:ANNKATRINE GATES PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNKATRINE
Authorized Official - Middle Name:LIEGMANN
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-800-9469
Mailing Address - Street 1:10 COOLIDGE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5510
Mailing Address - Country:US
Mailing Address - Phone:617-800-9469
Mailing Address - Fax:
Practice Address - Street 1:10 COOLIDGE HILL ROAD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5510
Practice Address - Country:US
Practice Address - Phone:617-800-9469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty