Provider Demographics
NPI:1942748462
Name:GILLE, ROCENY
Entity type:Individual
Prefix:
First Name:ROCENY
Middle Name:
Last Name:GILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1677
Mailing Address - Country:US
Mailing Address - Phone:609-705-5383
Mailing Address - Fax:609-561-0678
Practice Address - Street 1:5 S 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1677
Practice Address - Country:US
Practice Address - Phone:609-705-5383
Practice Address - Fax:609-561-0678
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00570300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional