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General NPI Number Information
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NPI Number | 1669663050
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Entity Type | Individual
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Provider Name | PHYLLIS GILDSTON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 275 MIDDLE NECK RD SUITE B-6
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City | GREAT NECK
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State | NY
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Zip | 11023-1925
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Country | US
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Telephone | 516-482-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 275 MIDDLE NECK RD SUITE B-6
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City | GREAT NECK
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State | NY
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Zip | 11023-1925
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Country | US
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Telephone | 516-482-4444
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000296-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000340-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 000080-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 000225-1
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License Number State | NY
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