Provider Demographics
NPI:1306653357
Name:RIBEIRO, GHENA (MS, LADC 1, MAPGS)
Entity type:Individual
Prefix:
First Name:GHENA
Middle Name:
Last Name:RIBEIRO
Suffix:
Gender:F
Credentials:MS, LADC 1, MAPGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LINCOLN STREET
Mailing Address - Street 2:PMB 326
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:315-439-2429
Mailing Address - Fax:
Practice Address - Street 1:14 TRAVERSE ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3343
Practice Address - Country:US
Practice Address - Phone:315-439-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2025-01-13
Deactivation Date:2024-12-13
Deactivation Code:
Reactivation Date:2025-01-13
Provider Licenses
StateLicense IDTaxonomies
MA18660101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)