Provider Demographics
NPI:1366653495
Name:GAY & JOHNSON, P.A.
Entity Type:Organization
Organization Name:GAY & JOHNSON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-656-1295
Mailing Address - Street 1:1311 N RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4259
Mailing Address - Country:US
Mailing Address - Phone:302-656-1295
Mailing Address - Fax:302-656-3316
Practice Address - Street 1:1311 N RODNEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4259
Practice Address - Country:US
Practice Address - Phone:302-656-1295
Practice Address - Fax:302-656-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00B740G54Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
DE134Medicare UPIN
DEG01154Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER