Provider Demographics
NPI:1184771685
Name:GAGNE, CYNTHIA P (MS, LMHC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:P
Last Name:GAGNE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 LUNENBURG ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4566
Mailing Address - Country:US
Mailing Address - Phone:978-342-0365
Mailing Address - Fax:978-342-0968
Practice Address - Street 1:348 LUNENBURG ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4566
Practice Address - Country:US
Practice Address - Phone:978-342-0365
Practice Address - Fax:978-342-0968
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019053OtherCIGNA
MAGALM0723OtherBCBS