Provider Demographics
NPI:1427384908
Name:GAMUT BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:GAMUT BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYCATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, BCBA
Authorized Official - Phone:267-253-5366
Mailing Address - Street 1:101 E 8TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1774
Mailing Address - Country:US
Mailing Address - Phone:267-253-5366
Mailing Address - Fax:
Practice Address - Street 1:101 E 8TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1774
Practice Address - Country:US
Practice Address - Phone:267-253-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-03-1364252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency