Provider Demographics
NPI:1942356639
Name:ORTHEN-GAMBILL, NILLA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:NILLA
Middle Name:M
Last Name:ORTHEN-GAMBILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:5 ESSEX GREEN DR
Mailing Address - Street 2:SUITE 22
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2929
Mailing Address - Country:US
Mailing Address - Phone:978-531-5517
Mailing Address - Fax:617-489-2645
Practice Address - Street 1:5 ESSEX GREEN DRIVE
Practice Address - Street 2:SUITE 22
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-531-5517
Practice Address - Fax:617-489-2645
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPR7729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05965OtherBCBS
MA238676000OtherMAGELLAN
MA238676000OtherMAGELLAN