Provider Demographics
NPI:1134556236
Name:FLORES, GINA (LICSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:DIFABIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 FOXBOROUGH BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2882
Mailing Address - Country:US
Mailing Address - Phone:908-358-2733
Mailing Address - Fax:
Practice Address - Street 1:100 FOXBOROUGH BLVD FL 2
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2882
Practice Address - Country:US
Practice Address - Phone:908-358-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW022291041C0700X
MA1279401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical