Provider Demographics
NPI:1588131007
Name:GILL, KATELYN (LMHC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 W OREILLY ST APT 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5731
Mailing Address - Country:US
Mailing Address - Phone:347-752-1039
Mailing Address - Fax:
Practice Address - Street 1:10300 SHORE FRONT PKWY APT 3D
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2774
Practice Address - Country:US
Practice Address - Phone:845-802-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP10763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health