Provider Demographics
NPI:1932913126
Name:GIL, TAE EUN
Entity type:Individual
Prefix:
First Name:TAE EUN
Middle Name:
Last Name:GIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COMMONWEALTH AVE UNIT 31
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02763-1182
Mailing Address - Country:US
Mailing Address - Phone:626-808-1617
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE UNIT 31
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02763-1182
Practice Address - Country:US
Practice Address - Phone:626-808-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI81021103TS0200X
NJ01851339103TS0200X
MA8010118103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool