Individual
DR. THERESA ELAINE GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1683 BEACON ST, BROOKLINE, MA 02445-4495
(617) 461-6936
(617) 353-5539
Mailing address
1683 BEACON ST, BROOKLINE, MA 02445-4495
(617) 461-6936
(617) 353-5539
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7990
MA
103TC0700X
Clinical Psychologist
989
NH
103TC0700X
Clinical Psychologist
PSY-2023-0082
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2053338
CIGNA PROVIDER #
MA
01
—
7813643
AETNA PROVIDER #
MA
01
—
W06227
BLUE CROSS BLUE SHIELD #
MA
Enumeration date
10/05/2006
Last updated
11/07/2023
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