Provider Demographics
NPI:1679714265
Name:SUMMERS, TRUDY A (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:A
Last Name:SUMMERS
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 1:17 ROGERS ST
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5038
Mailing Address - Country:US
Mailing Address - Phone:978-282-8808
Mailing Address - Fax:
Practice Address - Street 1:17 ROGERS ST
Practice Address - Street 2:SUITE 2-1
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5038
Practice Address - Country:US
Practice Address - Phone:978-282-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health