Provider Demographics
NPI:1821494915
Name:GILLEN, CAROL ANN GENDRON (LMHC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN GENDRON
Last Name:GILLEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CEDAR SWAMP RD
Mailing Address - Street 2:UNIT 206
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2447
Mailing Address - Country:US
Mailing Address - Phone:401-222-9882
Mailing Address - Fax:401-648-4854
Practice Address - Street 1:28 CEDAR SWAMP RD
Practice Address - Street 2:UNIT 206
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2447
Practice Address - Country:US
Practice Address - Phone:401-222-9882
Practice Address - Fax:401-648-4854
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health