=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366653495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAY & JOHNSON, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1311 N RODNEY ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-656-1295
-----------------------------------------------------
Fax | 302-656-3316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 N RODNEY ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-656-1295
-----------------------------------------------------
Fax | 302-656-3316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ELLEN LOUISE GAY
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 302-656-1295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | B1-0000106
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------