Provider Demographics
NPI:1992718043
Name:GILLEN, PATRICIA
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:GILLEN
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 1:40 GARDENVILLE PKWY STE 236
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1387
Mailing Address - Country:US
Mailing Address - Phone:716-604-7505
Mailing Address - Fax:716-668-2570
Practice Address - Street 1:40 GARDENVILLE PKWY STE 236
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1387
Practice Address - Country:US
Practice Address - Phone:716-604-7505
Practice Address - Fax:166-682-5707
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074944-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical