Healthcare Provider Details

I. General information

NPI: 1225876451
Provider Name (Legal Business Name): MONICA LIZETTE GORDILLO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROCKLAND RD FL 2
WILMINGTON DE
19803-3648
US

IV. Provider business mailing address

308 N MARKET ST UNIT 401
WILMINGTON DE
19801-2559
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4500
  • Fax:
Mailing address:
  • Phone: 323-363-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: