Provider Demographics
NPI:1437470929
Name:GORMLEY, JAIME NICOLE (MLADC)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:NICOLE
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1052
Mailing Address - Country:US
Mailing Address - Phone:603-881-4848
Mailing Address - Fax:603-598-3644
Practice Address - Street 1:615 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1052
Practice Address - Country:US
Practice Address - Phone:603-821-7788
Practice Address - Fax:603-598-3644
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15641041C0700X
NH0695101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)