Provider Demographics
NPI:1902672140
Name:GEARHART, MARINA GRETCHEN (LMHC, R-DMT)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:GRETCHEN
Last Name:GEARHART
Suffix:
Gender:F
Credentials:LMHC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 13TH ST UNIT 200
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2140
Mailing Address - Country:US
Mailing Address - Phone:978-994-4657
Mailing Address - Fax:
Practice Address - Street 1:58 13TH ST UNIT 200
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2140
Practice Address - Country:US
Practice Address - Phone:978-994-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001287101YM0800X
MA2663225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist