Basic Information
Provider Information
NPI: 1003001413
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RABBITT
FirstName: GINA
MiddleName: MARIE
NamePrefix: MISS
NameSuffix:  
Credential: M.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3 RED JACKET LN
Address2:  
City: SALEM
State: MA
PostalCode: 019706839
CountryCode: US
TelephoneNumber: 3392210560
FaxNumber:  
Practice Location
Address1: 172 LAFAYETTE ST
Address2:  
City: SALEM
State: MA
PostalCode: 019704815
CountryCode: US
TelephoneNumber: 9787441386
FaxNumber: 9787404996
Other Information
ProviderEnumerationDate: 09/10/2007
LastUpdateDate: 09/10/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XS15495922MAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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