| Doctor Name: | MS. GWENDOLYN M. VINCENT |
| NPI Number: | 1437408374 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.W. |
| License Number: | |
| Business Practice Address: | 1613 Blule Hill Avenue Suite 302 Mattapan, MA - 021262123 |
| Business Phone Number: | 8575984774 |
| Business Fax Number: | 8575984816 |
| Mailing Address: | 1613 Blue Hill Avenue/suite 302, MATTAPAN |
| State: | MA |
| Postal Code: | 021262123 |
| Phone Number: | 8575984774 |
| Fax Number: | 8575984816 |
| NPI Enumeration Date: | 09/06/2012 |
| NPI Last Update Date: | 09/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |