Individual
ROBERT WILLSON GILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
215 WASHINGTON AVENUE EXT, ALBANY, NY 12205-5534
(518) 452-0914
(518) 452-5953
Mailing address
215 WASHINGTON AVENUE EXT, ALBANY, NY 12205-5534
(518) 452-0914
(518) 452-5953
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
7574
NY
103T00000X
Psychologist
007574
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01698773
—
NY
Enumeration date
10/21/2005
Last updated
05/19/2021
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