Provider Demographics
NPI:1548208341
Name:GINGRAS, NORMAND A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:NORMAND
Middle Name:A
Last Name:GINGRAS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BRICK KILN RD
Mailing Address - Street 2:3-304
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3239
Mailing Address - Country:US
Mailing Address - Phone:978-387-5372
Mailing Address - Fax:978-319-9598
Practice Address - Street 1:1 OLDE NORTH RD
Practice Address - Street 2:#104
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1453
Practice Address - Country:US
Practice Address - Phone:978-710-6574
Practice Address - Fax:978-319-9598
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110101793AMedicaid
MAVX2646Medicare UPIN
MAP2371503Medicare UPIN
MA110101793AMedicaid