Fanning Tacoaman, Gloria Leyla

Fanning Tacoaman, Gloria Leyla is an individual health care provider with primary practice located at 60 Concord St Ste 1 , Wilmington MA 01887-2179. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Fanning Tacoaman, Gloria Leyla can be contacted via phone (781) 694-8787.

Contact Information

Primary practice address
60 Concord St Ste 1 Wilmington MA 01887-2179
Phone: (781) 694-8787
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X LABA10000079 Massachusetts

Profile Details

NPI number 1053921114
LBN Legal business name Fanning Tacoaman, Gloria Leyla
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 4th, 2020
Last updated May 9th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053921114 NPPES
Massachusetts MEDICAID 110026265E

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