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General NPI Number Information
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NPI Number | 1548356363
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Entity Type | Individual
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Provider Name | THERESA ELAINE GILMORE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 1683 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-4495
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Country | US
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Telephone | 617-461-6936
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Fax | 617-353-5539
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Provider Business Mailing Address
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Address Line | 1683 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-4495
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Country | US
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Telephone | 617-461-6936
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Fax | 617-353-5539
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 989
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-2023-0082
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7990
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License Number State | MA
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