Provider Demographics
NPI:1588630909
Name:STREETER, GRETCHEN PAULEY (LICSW)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:PAULEY
Last Name:STREETER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:M
Other - Last Name:PAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1 WALPOLE ST
Mailing Address - Street 2:STE 8
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3315
Mailing Address - Country:US
Mailing Address - Phone:617-942-1520
Mailing Address - Fax:781-769-7008
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:STE 8
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:617-906-5545
Practice Address - Fax:617-906-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1113931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22971Medicare ID - Type Unspecified