Healthcare Provider Details

I. General information

NPI: 1588629844
Provider Name (Legal Business Name): KATHLEEN MARY GILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WESTFALL RD ROPC - BEHAVIORAL HEALTH
ROCHESTER NY
14620-4645
US

IV. Provider business mailing address

465 WESTFALL RD ROPC - BEHAVIORAL HEALTH
ROCHESTER NY
14620-4645
US

V. Phone/Fax

Practice location:
  • Phone: 585-463-2677
  • Fax: 585-463-2669
Mailing address:
  • Phone: 585-463-2677
  • Fax: 585-463-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014349
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number014349
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: