Provider Demographics
NPI:1689847659
Name:GAMBLE, SHANNON R (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9734
Mailing Address - Country:US
Mailing Address - Phone:413-367-2299
Mailing Address - Fax:
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1526
Practice Address - Country:US
Practice Address - Phone:413-773-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health