Provider Demographics
NPI:1316606858
Name:GICHUKI, LOICE
Entity type:Individual
Prefix:
First Name:LOICE
Middle Name:
Last Name:GICHUKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-3416
Mailing Address - Country:US
Mailing Address - Phone:781-513-0224
Mailing Address - Fax:
Practice Address - Street 1:140 WORCESTER PROVIDENCE TPKE STE 4
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-2448
Practice Address - Country:US
Practice Address - Phone:781-513-0224
Practice Address - Fax:508-256-2650
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty