Provider Demographics
NPI:1346805801
Name:AMSHALOM, GILAD (SLP, IMH)
Entity Type:Individual
Prefix:
First Name:GILAD
Middle Name:
Last Name:AMSHALOM
Suffix:
Gender:M
Credentials:SLP, IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PILGRIM ST APT 202
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4197
Mailing Address - Country:US
Mailing Address - Phone:617-460-1121
Mailing Address - Fax:
Practice Address - Street 1:12 TYLER ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3241
Practice Address - Country:US
Practice Address - Phone:617-629-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health