Provider Demographics
NPI:1912046376
Name:RAHILLY, GWEN J (MS)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:J
Last Name:RAHILLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COLONY LN
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-1404
Mailing Address - Country:US
Mailing Address - Phone:413-734-4978
Mailing Address - Fax:413-734-0467
Practice Address - Street 1:235 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1100
Practice Address - Country:US
Practice Address - Phone:413-734-4978
Practice Address - Fax:413-734-0467
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health