Provider Demographics
NPI:1528115979
Name:WEST, GATEWOOD (LICSW)
Entity type:Individual
Prefix:MS
First Name:GATEWOOD
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CREIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2004
Mailing Address - Country:US
Mailing Address - Phone:617-876-7360
Mailing Address - Fax:617-876-7360
Practice Address - Street 1:ONE MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:978-250-8880
Practice Address - Fax:617-876-7360
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21939Medicare ID - Type Unspecified