Provider Demographics
NPI:1508019381
Name:GEBHARDT, SHAWN MICHAEL (MS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHAEL
Last Name:GEBHARDT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AUTUM LN
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966
Mailing Address - Country:US
Mailing Address - Phone:978-705-1979
Mailing Address - Fax:707-202-1979
Practice Address - Street 1:20 LOCOST ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-705-1979
Practice Address - Fax:707-202-1979
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health