Provider Demographics
NPI:1558422097
Name:GILDEA, THOMAS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GILDEA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 N CHAPEL ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2238
Mailing Address - Country:US
Mailing Address - Phone:302-738-3739
Mailing Address - Fax:302-738-6734
Practice Address - Street 1:62 N CHAPEL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-2238
Practice Address - Country:US
Practice Address - Phone:302-738-3739
Practice Address - Fax:302-738-6734
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE081808Medicare ID - Type Unspecified