Provider Demographics
NPI:1174187272
Name:GILMAN, BETH (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GILMAN
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WYNMILL PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1801
Mailing Address - Country:US
Mailing Address - Phone:215-677-5332
Mailing Address - Fax:
Practice Address - Street 1:631 WYNMILL PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1801
Practice Address - Country:US
Practice Address - Phone:215-677-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004791-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist