Provider Demographics
NPI:1265633283
Name:GILLEN, CONSTANCE AMES (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:AMES
Last Name:GILLEN
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 1:136 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2048
Mailing Address - Country:US
Mailing Address - Phone:413-549-5034
Mailing Address - Fax:
Practice Address - Street 1:136 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2048
Practice Address - Country:US
Practice Address - Phone:413-549-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1617103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling