Healthcare Provider Details

I. General information

NPI: 1750944047
Provider Name (Legal Business Name): NANCY GILLON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 TEANECK RD
TEANECK NJ
07666-3626
US

IV. Provider business mailing address

18 THATCHER RD
TENAFLY NJ
07670-2921
US

V. Phone/Fax

Practice location:
  • Phone: 201-837-9090
  • Fax:
Mailing address:
  • Phone: 201-341-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05843500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: