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General NPI Number Information
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NPI Number | 1952777187
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Entity Type | Organization
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Legal Business Name | GILL FORENSIC SERVICES, LLC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 125 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10017-5529
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Country | US
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Telephone | 646-477-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 OVERLOOK CIR
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City | PIERMONT
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State | NY
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Zip | 10968-1288
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Country | US
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Telephone | 845-680-6746
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Fax | 845-680-6746
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Authorized Official
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Title or Position | FORENSIC DEATH AND PSYCH EXAMINER
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Name | DR. SHELLY NYCOLE GILL
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Credential | PHD
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Telephone | 845-521-8321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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