Provider Demographics
NPI:1255422770
Name:RACICOT, GAIL ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:RACICOT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 541 MO
Mailing Address - Street 2:250 BOSTON TURNPIKE
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545
Mailing Address - Country:US
Mailing Address - Phone:508-752-7514
Mailing Address - Fax:508-842-5676
Practice Address - Street 1:250 BOSTON TURNPIKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545
Practice Address - Country:US
Practice Address - Phone:508-752-7514
Practice Address - Fax:508-842-5676
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
051464000OtherMAGELLAN
1899147OtherUNISYS
407804OtherBCBS RI
5124768401OtherUBH
1017680OtherBEACON
W04622OtherBCBS
MA1899147Medicaid
1000439OtherCIGNA
732404OtherTUFTS
732404OtherTUFTS