Provider Demographics
NPI:1972630622
Name:ST. LOUIS, GEMIMA (PHD)
Entity Type:Individual
Prefix:
First Name:GEMIMA
Middle Name:
Last Name:ST. LOUIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RIVER ST
Mailing Address - Street 2:SPARK CENTER-BMC
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126
Mailing Address - Country:US
Mailing Address - Phone:617-534-2050
Mailing Address - Fax:617-534-2057
Practice Address - Street 1:255 RIVER ST
Practice Address - Street 2:SPARK CENTER-BMC
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126
Practice Address - Country:US
Practice Address - Phone:617-534-2050
Practice Address - Fax:617-534-2057
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist