Provider Demographics
NPI:1740610070
Name:MYLES, GWENETH CHRISTINE (MED)
Entity Type:Individual
Prefix:
First Name:GWENETH
Middle Name:CHRISTINE
Last Name:MYLES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ARCH PL
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2457
Mailing Address - Country:US
Mailing Address - Phone:413-737-9544
Mailing Address - Fax:413-737-4455
Practice Address - Street 1:130 MAPLE ST STE 325
Practice Address - Street 2:130 MAPLE STREET SUIT 325
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2215
Practice Address - Country:US
Practice Address - Phone:413-737-9544
Practice Address - Fax:413-737-4455
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$-AMedicare PIN