Provider Demographics
NPI:1467698027
Name:LORRAINE GAHLES-KILDOW, PHD LLC
Entity Type:Organization
Organization Name:LORRAINE GAHLES-KILDOW, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAHLES-KILDOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-337-1392
Mailing Address - Street 1:2086 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1812
Mailing Address - Country:US
Mailing Address - Phone:908-337-1392
Mailing Address - Fax:
Practice Address - Street 1:2086 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1812
Practice Address - Country:US
Practice Address - Phone:908-337-1392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI003698261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)