Individual
PETER J GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1011 VETERANS MEMORIAL PKWY, EAST PROVIDENCE, RI 02915-5061
(402) 432-1533
(401) 432-1500
Mailing address
1011 VETERANS MEMORIAL PKWY, EAST PROVIDENCE, RI 02915-5061
(402) 432-1284
(401) 432-1509
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS00823
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9613312
AETNA HEALTHCARE
RI
05
—
PG70349
—
RI
Enumeration date
06/04/2006
Last updated
01/06/2011
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