Provider Demographics
NPI:1588907091
Name:GATELY, COREY E (MLADC, SAP)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:E
Last Name:GATELY
Suffix:
Gender:F
Credentials:MLADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HIGHLAND ST
Mailing Address - Street 2:LRGHEALTHCARE OCCUPATIONAL HEALTH SERVICES
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3235
Mailing Address - Country:US
Mailing Address - Phone:603-524-5816
Mailing Address - Fax:603-524-6984
Practice Address - Street 1:80 HIGHLAND ST
Practice Address - Street 2:LRGHEALTHCARE OCCUPATIONAL HEALTH SERVICES
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3235
Practice Address - Country:US
Practice Address - Phone:603-524-5816
Practice Address - Fax:603-524-6984
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0633101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)