Provider Demographics
NPI:1942815493
Name:GILMORE, TENEALIA ANN
Entity Type:Individual
Prefix:MS
First Name:TENEALIA
Middle Name:ANN
Last Name:GILMORE
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 1:32 KINGSDALE ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1714
Mailing Address - Country:US
Mailing Address - Phone:857-389-0111
Mailing Address - Fax:
Practice Address - Street 1:3313 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2691
Practice Address - Country:US
Practice Address - Phone:617-522-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical