Provider Demographics
NPI:1780624924
Name:GANTMAN, SHARON BETH (LICSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:BETH
Last Name:GANTMAN
Suffix:
Gender:F
Credentials:LICSW
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 276
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-0376
Mailing Address - Country:US
Mailing Address - Phone:978-609-5226
Mailing Address - Fax:978-465-5034
Practice Address - Street 1:10 PRINCE PL 107
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2657
Practice Address - Country:US
Practice Address - Phone:978-465-5033
Practice Address - Fax:978-465-5034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07782OtherBCBS
MAP07782OtherBCBS