Provider Demographics
NPI:1669493409
Name:CATTELL, GWYN MORWENA (MD)
Entity type:Individual
Prefix:
First Name:GWYN
Middle Name:MORWENA
Last Name:CATTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GWYN
Other - Middle Name:CATTELL
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:84 GALVIN RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:VT
Mailing Address - Zip Code:05778-4400
Mailing Address - Country:US
Mailing Address - Phone:802-349-1636
Mailing Address - Fax:802-623-6732
Practice Address - Street 1:84 GALVIN RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:VT
Practice Address - Zip Code:05778-4400
Practice Address - Country:US
Practice Address - Phone:978-480-0033
Practice Address - Fax:802-623-6732
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1506382084P0800X, 2084P0804X
VT042.00133412084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1100893409Medicaid
VT1100893409Medicaid