Provider Demographics
NPI:1629360235
Name:KILGALLEN, CHRISTINA EMER (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:EMER
Last Name:KILGALLEN
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 1:41 PINELAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-5111
Mailing Address - Country:US
Mailing Address - Phone:207-688-2253
Mailing Address - Fax:
Practice Address - Street 1:41 PINELAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-5111
Practice Address - Country:US
Practice Address - Phone:207-688-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1310103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist