Provider Demographics
NPI:1730410689
Name:GATELY, THERESA A (FAMILY PARTNER)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:A
Last Name:GATELY
Suffix:
Gender:F
Credentials:FAMILY PARTNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1714
Mailing Address - Country:US
Mailing Address - Phone:857-939-1190
Mailing Address - Fax:
Practice Address - Street 1:4121 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1714
Practice Address - Country:US
Practice Address - Phone:857-939-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker