Provider Demographics
NPI:1427329432
Name:GILLIS, SIMONE ROBIN (MSMHC)
Entity type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:ROBIN
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MSMHC
Other - Prefix:MS
Other - First Name:SIMONE
Other - Middle Name:ROBIN
Other - Last Name:GILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSMHC
Mailing Address - Street 1:1 OLD FENCE LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3720
Mailing Address - Country:US
Mailing Address - Phone:610-938-9381
Mailing Address - Fax:610-957-5406
Practice Address - Street 1:800 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3826
Practice Address - Country:US
Practice Address - Phone:610-938-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health