Provider Demographics
NPI:1528166188
Name:GATES, FREDERICK L (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:GATES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5960
Mailing Address - Country:US
Mailing Address - Phone:781-820-7597
Mailing Address - Fax:
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-787-4662
Practice Address - Fax:617-787-4662
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3106103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA700176OtherTUFTS (INDIVIDUAL)
MA602105OtherTUFTS (GROUP#)
MA004717OtherPACIFICARE
MA27870OtherHMO MAGELAN INDIVIDUAL #
MA602105OtherTUFTS (GROUP#)