Provider Demographics
NPI:1477787729
Name:GAMACHE, KYLE NORMAND (LMHC, QMHP)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:NORMAND
Last Name:GAMACHE
Suffix:
Gender:M
Credentials:LMHC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2716
Mailing Address - Country:US
Mailing Address - Phone:401-374-5218
Mailing Address - Fax:
Practice Address - Street 1:50 BALLSTON AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2716
Practice Address - Country:US
Practice Address - Phone:401-374-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health