Basic Information
| Provider Information | |||||||||
| NPI: | 1588130439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISH | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | CHELLMAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100A HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786825276 | ||||||||
| FaxNumber: | 9786884932 | ||||||||
| Practice Location | |||||||||
| Address1: | 100A HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786825276 | ||||||||
| FaxNumber: | 9786884932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2018 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3380 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.