Provider Demographics
NPI:1568769560
Name:WILCOX, GABRIELLE MAE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:MAE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OREGON PIKE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4372
Mailing Address - Country:US
Mailing Address - Phone:717-397-1400
Mailing Address - Fax:
Practice Address - Street 1:1525 OREGON PIKE
Practice Address - Street 2:SUITE 501
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4372
Practice Address - Country:US
Practice Address - Phone:717-397-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016965103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist