Provider Demographics
NPI:1346595733
Name:GNATOVICH, STANA MUSKIN (LMFT)
Entity Type:Individual
Prefix:
First Name:STANA
Middle Name:MUSKIN
Last Name:GNATOVICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 HANCOCK ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4300
Mailing Address - Country:US
Mailing Address - Phone:617-745-4100
Mailing Address - Fax:
Practice Address - Street 1:1212 HANCOCK ST
Practice Address - Street 2:SUITE 205
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4300
Practice Address - Country:US
Practice Address - Phone:617-745-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-21
Last Update Date:2012-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist