Provider Demographics
NPI:1750864898
Name:GANNON, HELEN A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:HELEN
Middle Name:A
Last Name:GANNON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-1418
Mailing Address - Country:US
Mailing Address - Phone:413-746-6776
Mailing Address - Fax:
Practice Address - Street 1:155 MILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-1045
Practice Address - Country:US
Practice Address - Phone:413-886-0100
Practice Address - Fax:413-886-0123
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110210-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical