Healthcare Provider Details

I. General information

NPI: 1780946004
Provider Name (Legal Business Name): MS. HARLENE GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 PRE EMPTION RD
GENEVA NY
14456-1335
US

IV. Provider business mailing address

731 PRE EMPTION RD
GENEVA NY
14456-1335
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-6828
  • Fax: 315-789-7750
Mailing address:
  • Phone: 315-789-6828
  • Fax: 315-789-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: