Provider Demographics
NPI:1588629844
Name:GILL, KATHLEEN MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:GILL
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 1:465 WESTFALL RD
Mailing Address - Street 2:ROPC - BEHAVIORAL HEALTH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4645
Mailing Address - Country:US
Mailing Address - Phone:585-463-2677
Mailing Address - Fax:585-463-2669
Practice Address - Street 1:465 WESTFALL RD
Practice Address - Street 2:ROPC - BEHAVIORAL HEALTH
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4645
Practice Address - Country:US
Practice Address - Phone:585-463-2677
Practice Address - Fax:585-463-2669
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014349103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service