Provider Demographics
NPI:1629022439
Name:GAULIN, ANN EILEEN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:EILEEN
Last Name:GAULIN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 HECKLE ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3169
Mailing Address - Country:US
Mailing Address - Phone:610-246-0679
Mailing Address - Fax:610-775-1020
Practice Address - Street 1:122 W LANCASTER AVE
Practice Address - Street 2:SUITE 01
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1881
Practice Address - Country:US
Practice Address - Phone:610-246-0679
Practice Address - Fax:610-775-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000103106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010198050001Medicaid