Provider Demographics
NPI:1366656407
Name:GAMBACCINI, ELIZABETH ANNE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:GAMBACCINI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:356C BROAD STREET, 3RD FLOOR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-589-1524
Practice Address - Street 1:80 ERDMAN WAY STE 103B
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:888-589-1524
Practice Address - Fax:888-589-1524
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health