Provider Demographics
NPI:1811083421
Name:GABOURY, MICHELE A (MSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:GABOURY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEETINGHOUSE ROAD
Mailing Address - Street 2:PO BOX 1033
Mailing Address - City:LITTLEOTN
Mailing Address - State:MA
Mailing Address - Zip Code:01460
Mailing Address - Country:US
Mailing Address - Phone:978-952-0150
Mailing Address - Fax:978-952-6322
Practice Address - Street 1:75 MOUNT AUBURN STREET
Practice Address - Street 2:HARVARD UNIVERSITY, CAMHS
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-495-2042
Practice Address - Fax:617-496-6890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO3284OtherBC/BS PROVIDER NUMBER
MA101867OtherMAGELLAN PROVIDER NUMBER
MA105122OtherLICSW
MA5144002OtherAETNA PROVIDER NUMBER
MA766044OtherTUFTS PROVIDER NUMBER
MA216598OtherMANAGED HEALTH NETWORK PR
MA2073786OtherCIGNA PROVIDER NUMBER
MA101867OtherMAGELLAN PROVIDER NUMBER