Provider Demographics
NPI:1619137957
Name:AUSTRICH, GLORIA MARIA (NCSP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MARIA
Last Name:AUSTRICH
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1349
Mailing Address - Country:US
Mailing Address - Phone:781-335-1005
Mailing Address - Fax:617-524-8831
Practice Address - Street 1:1960 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3219
Practice Address - Country:US
Practice Address - Phone:617-516-0280
Practice Address - Fax:617-516-0281
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA304078103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool