Provider Demographics
NPI:1780016220
Name:GILLIGAN, KELLEY ANNE
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANNE
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 HAMBURG ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-4343
Mailing Address - Country:US
Mailing Address - Phone:518-357-2909
Mailing Address - Fax:518-357-2937
Practice Address - Street 1:2925 HAMBURG ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4343
Practice Address - Country:US
Practice Address - Phone:518-357-2909
Practice Address - Fax:518-357-2937
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)