Individual
MR. STEPHEN MICHAEL GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC1
Contact information
Practice address
1010 VARNUM AVE, LOWELL, MA 01854-1915
(617) 529-5511
Mailing address
29 VENUS WAY, PELHAM, NH 03076-2126
(617) 529-5511
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22822
MA
251B00000X
Case Management Agency
—
—
Other
Enumeration date
12/16/2010
Last updated
02/16/2025
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