Provider Demographics
NPI:1447855960
Name:WEYMOUTH, GENEVA GANN (LMHC)
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:GANN
Last Name:WEYMOUTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GENEVA
Other - Middle Name:
Other - Last Name:GANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:41 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2518
Mailing Address - Country:US
Mailing Address - Phone:847-912-0338
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL STE 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2999
Practice Address - Country:US
Practice Address - Phone:617-638-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health