MEDICARE: AVIVA GASKILL, PHD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1912471350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIVA GASKILL, PHD, PLLC

Provider Business Mailing Address
First Line	:	308 EAST LANCASTER AVENUE
Second Line	:	SUITE 200
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2145
Country	:	US
Telephone Number	:	856-392-7692
Fax Number	:	610-642-3278

Provider Business Practice Location Address
First Line	:	308 EAST LANCASTER AVENUE
Second Line	:	SUITE 200
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2145
Country	:	US
Telephone Number	:	856-392-7692
Fax Number	:	610-642-3278

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. AVIVA SHARON GASKILL
Credential	:	PHD
Telephone Number	:	856-392-7692

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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