Provider Demographics
NPI:1699252643
Name:GAYLE, CHERYL ANN (LICSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:GAYLE
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:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1018
Mailing Address - Country:US
Mailing Address - Phone:508-237-5591
Mailing Address - Fax:
Practice Address - Street 1:68 ROUTE 134
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3710
Practice Address - Country:US
Practice Address - Phone:508-394-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10158331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical