Provider Demographics
NPI:1992913198
Name:GILLOCK, JAMES BRAGONIER (EDD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRAGONIER
Last Name:GILLOCK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WEST STATE STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-431-6987
Mailing Address - Fax:267-685-4292
Practice Address - Street 1:127 STATE STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:215-968-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004175-L103G00000X
PAPS-004175-L103T00000X
NJ1838103T00000X
NY010299103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist