Provider Demographics
NPI:1326174731
Name:GILLES-THOMAS, ANNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:E
Last Name:GILLES-THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3803
Mailing Address - Country:US
Mailing Address - Phone:716-204-5258
Mailing Address - Fax:716-204-5259
Practice Address - Street 1:4511 HARLEM RD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3803
Practice Address - Country:US
Practice Address - Phone:716-204-5258
Practice Address - Fax:716-204-5259
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012530-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026410601OtherUNIVERA HEALTHCARE
NY000527429001OtherBLUE CROSS BLUE SHIELD
NY00026410601OtherUNIVERA HEALTHCARE