Provider Demographics
NPI:1952433815
Name:KIRK, GAYLE L (MSW)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:KIRK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:L
Other - Last Name:CRAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:80 HENRY DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1582
Mailing Address - Country:US
Mailing Address - Phone:781-535-7887
Mailing Address - Fax:
Practice Address - Street 1:282 BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2919
Practice Address - Country:US
Practice Address - Phone:617-598-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685661OtherTUFTS
MA1312677Medicaid
MAM18708OtherBLUE CROSS
MAM18708OtherBLUE CROSS