Doctor Name: | MRS. GAYLE PATRICIA HEARNS-ROGERS |
NPI Number: | 1063631828 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC-1, CAS |
License Number: | |
Business Practice Address: | 11 Circle Ave Lynn, MA - 019053050 |
Business Phone Number: | 7813568017 |
Business Fax Number: | 7815980210 |
Mailing Address: | 11 Circle Ave, LYNN |
State: | MA |
Postal Code: | 019053050 |
Phone Number: | 7813568017 |
Fax Number: | 7815980210 |
NPI Enumeration Date: | 04/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |