Healthcare Provider Details

I. General information

NPI: 1336583459
Provider Name (Legal Business Name): SUSAN ELISABETH GILLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N HARRISON AVE SUITE 100
CARY NC
27513-2410
US

IV. Provider business mailing address

1901 N HARRISON AVE SUITE 100
CARY NC
27513-2410
US

V. Phone/Fax

Practice location:
  • Phone: 919-677-0101
  • Fax: 919-677-0113
Mailing address:
  • Phone: 919-677-0101
  • Fax: 919-677-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4452
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: