Provider Demographics
NPI:1356462113
Name:SECORD, GAYLE JEANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:JEANNETTE
Last Name:SECORD
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:PO BOX 2522
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-7522
Mailing Address - Country:US
Mailing Address - Phone:781-329-1891
Mailing Address - Fax:781-762-0739
Practice Address - Street 1:15 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2153
Practice Address - Country:US
Practice Address - Phone:781-329-1891
Practice Address - Fax:781-762-0739
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4715 PR103G00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TE1100X, 103TF0000X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASEW04554Medicare ID - Type UnspecifiedMEDICARE
MAW04554Medicare ID - Type Unspecified
MAW04554Medicare UPIN