Individual
DR. ELIZABETH MAINZER GAGNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
77 FRANKLIN ST, SUITE 809, BOSTON, MA 02110-1510
(617) 451-0055
(617) 451-0055
Mailing address
77 FRANKLIN ST, SUITE 809, BOSTON, MA 02110-1510
(617) 451-0055
(617) 451-0055
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
8186
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W06313
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/19/2007
Last updated
09/22/2016
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