Provider Demographics
NPI:1922106525
Name:GILLEN, EILEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:GILLEN
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 1:7 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3339
Mailing Address - Country:US
Mailing Address - Phone:856-778-8891
Mailing Address - Fax:856-778-1270
Practice Address - Street 1:7 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3339
Practice Address - Country:US
Practice Address - Phone:856-778-8891
Practice Address - Fax:856-778-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00286900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA354747OtherBENEFIT CONCEPTS
MD100056715001OtherAPS HEALTHCARE
PA108614OtherCOVENTRY HEALTH AND LIFE
NJ47820OtherCIGNA
NJ050632OtherVALUE OPTIONS
MD100056715001OtherAPS HEALTHCARE