Provider Demographics
NPI:1811014749
Name:GAHLES-KILDOW, LORRAINE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:ANN
Last Name:GAHLES-KILDOW
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 1:2086 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1812
Mailing Address - Country:US
Mailing Address - Phone:908-322-2181
Mailing Address - Fax:
Practice Address - Street 1:1812 FRONT ST
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1103
Practice Address - Country:US
Practice Address - Phone:908-322-9960
Practice Address - Fax:908-322-8961
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00369800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist