Provider Demographics
NPI:1730239328
Name:GALE, LAURA ANN DA COSTA (LICSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN DA COSTA
Last Name:GALE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARKET SQ
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2497
Mailing Address - Country:US
Mailing Address - Phone:978-388-0606
Mailing Address - Fax:978-388-0006
Practice Address - Street 1:5 MARKET SQ
Practice Address - Street 2:SUITE 206
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2497
Practice Address - Country:US
Practice Address - Phone:978-388-0606
Practice Address - Fax:978-388-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10166581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical