Provider Demographics
NPI:1528835568
Name:DILEO, GINA MARIE (LLP)
Entity type:Individual
Prefix:
First Name:GINA MARIE
Middle Name:
Last Name:DILEO
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 SIGNATURE BLVD APT M
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6486
Mailing Address - Country:US
Mailing Address - Phone:516-301-8277
Mailing Address - Fax:
Practice Address - Street 1:3065 SIGNATURE BLVD APT M
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6486
Practice Address - Country:US
Practice Address - Phone:516-301-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009689103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic