Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4715 PR | MA |
N | 103TC0700X | Clinical Psychologist | 4715 PR | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 4715 PR | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 4715 PR | MA |
Y | 103G00000X | Clinical Psychologist | 4715 PR | MA |
Y | 103TC0700X | Clinical Psychologist | 4715 PR | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4715 PR | MA |
N | 103TE1100X | Exercise & Sports Psychologist | 4715 PR | MA |
N | 103TF0000X | Family Psychologist | 4715 PR | MA |
N | 103TH0004X | Health Psychologist | 4715 PR | MA |
NPI | 1356462113 |
---|---|
Provider Name | Dr. Gayle Jeannette Secord |
First Address | Westwood, MA 02090-7522 |
Second Address | Norwood, MA 02062-2153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 29/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W04554 | (02) | MA |