Basic Information
| Provider Information | |||||||||
| NPI: | 1346805801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMSHALOM | ||||||||
| FirstName: | GILAD | ||||||||
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| Credential: | SLP, IMH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 PILGRIM ST APT 202 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021394197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174601121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 TYLER ST | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021433241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176293919 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2019 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.