Provider Demographics
NPI:1689709032
Name:GASTMAN, GARY BRETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRETT
Last Name:GASTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:35 MARKET ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1805
Mailing Address - Country:US
Mailing Address - Phone:978-459-0389
Mailing Address - Fax:978-459-7642
Practice Address - Street 1:35 MARKET ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1805
Practice Address - Country:US
Practice Address - Phone:978-459-0389
Practice Address - Fax:978-459-7642
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W50056Medicare ID - Type UnspecifiedPROVIDER NUMBER