Provider Demographics
NPI:1306892898
Name:GAMMON, WILLIAM DOUGLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:GAMMON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:572 BOSTON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821
Mailing Address - Country:US
Mailing Address - Phone:781-696-2070
Mailing Address - Fax:978-294-8977
Practice Address - Street 1:572 BOSTON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3776
Practice Address - Country:US
Practice Address - Phone:781-696-2070
Practice Address - Fax:978-294-8977
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02490Medicare ID - Type UnspecifiedPROVIDER NUMBER