Provider Demographics
NPI:1659438794
Name:GACHUNA, THERESA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:GACHUNA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:LORRAINE
Other - Last Name:GACHUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:326 NICHOLS ROAD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:978-878-8516
Mailing Address - Fax:978-878-8418
Practice Address - Street 1:175 CONNORS STREET
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-410-6131
Practice Address - Fax:978-410-6106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146141041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical