Provider Demographics
NPI:1497992911
Name:FLAHERTY, GAYLE LOUISE (OTR/L, LICSW)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:LOUISE
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:OTR/L, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8873
Mailing Address - Country:US
Mailing Address - Phone:781-648-4011
Mailing Address - Fax:
Practice Address - Street 1:106 LAKE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8873
Practice Address - Country:US
Practice Address - Phone:781-648-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10205831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000P07159OtherBCBSMA