Provider Demographics
NPI:1598837189
Name:GAMACHE, CORINNE ELIZABETH (LMHC, MA-MT)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:ELIZABETH
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:LMHC, MA-MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2432
Mailing Address - Country:US
Mailing Address - Phone:617-777-4240
Mailing Address - Fax:
Practice Address - Street 1:218 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2432
Practice Address - Country:US
Practice Address - Phone:617-777-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1598837189Medicaid