Provider Demographics
NPI:1568472322
Name:SMITH, GAIL C (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13C MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754
Mailing Address - Country:US
Mailing Address - Phone:508-829-3648
Mailing Address - Fax:
Practice Address - Street 1:100 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1804
Practice Address - Country:US
Practice Address - Phone:978-466-8397
Practice Address - Fax:978-537-3496
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health