Provider Demographics
NPI:1124351069
Name:DESMOND, CECILE GUNN (MDIV)
Entity type:Individual
Prefix:MS
First Name:CECILE
Middle Name:GUNN
Last Name:DESMOND
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:CECILE
Other - Middle Name:CHER
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MDIV
Mailing Address - Street 1:185 BAY STATE RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1506
Mailing Address - Country:US
Mailing Address - Phone:617-353-9738
Mailing Address - Fax:
Practice Address - Street 1:185 BAY STATE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1506
Practice Address - Country:US
Practice Address - Phone:617-353-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling