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General NPI Number Information
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NPI Number | 1023200730
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Entity Type | Organization
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Legal Business Name | MICHAEL R. GILDEA PC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 88 N BULL RUN XING SUITE 6
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City | LEWISBURG
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State | PA
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Zip | 17837-6725
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Country | US
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Telephone | 570-522-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 88 N BULL RUN XING SUITE 6
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City | LEWISBURG
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State | PA
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Zip | 17837-6725
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Country | US
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Telephone | 570-522-8330
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. MICHAEL RICHARD GILDEA
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Credential | M.S.ED., LPC, CAC
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Telephone | 570-522-8330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 607049
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License Number State | PA
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