Provider Demographics
NPI:1558499210
Name:GAY, JOAN B (LICSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:B
Last Name:GAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LACLEDE AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4248
Mailing Address - Country:US
Mailing Address - Phone:508-877-3824
Mailing Address - Fax:
Practice Address - Street 1:10 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1123
Practice Address - Country:US
Practice Address - Phone:781-493-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1003781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100378OtherSOCIAL WORK LICENSE