Provider Demographics
NPI:1003289729
Name:GAVIN, CAROL (PMHNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GAVIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TELEMYND
Mailing Address - Street 2:141 PARKER ST SUITE 306
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754
Mailing Address - Country:US
Mailing Address - Phone:866-991-2163
Mailing Address - Fax:
Practice Address - Street 1:TELEMYND
Practice Address - Street 2:141 PARKER ST SUITE 306
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754
Practice Address - Country:US
Practice Address - Phone:866-991-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173036363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health