Basic Information
| Provider Information | |||||||||
| NPI: | 1447855960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEYMOUTH | ||||||||
| FirstName: | GENEVA | ||||||||
| MiddleName: | GANN | ||||||||
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| Credential: | LMHC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GANN | ||||||||
| OtherFirstName: | GENEVA | ||||||||
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| OtherCredential: | LMHC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 41 CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020212518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479120338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL STE 1 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2020 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9701 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.