Robert Willson Gillen, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

7574 Issued in NY

Practice address

215 Washington Avenue Ext
Albany, NY 12205-5534

Phone

(518) 452-0914

Fax

(518) 452-5953

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1245220227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 WASHINGTON AVENUE EXT",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055534",
            "telephone_number": "518-452-0914",
            "fax_number": "518-452-5953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 WASHINGTON AVENUE EXT",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055534",
            "telephone_number": "518-452-0914",
            "fax_number": "518-452-5953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1270 Belmont Ave",
            "address_purpose": "LOCATION",
            "city": "Schenectady",
            "state": "NY",
            "postal_code": "123082104",
            "country_code": "US",
            "telephone_number": "518-382-4500",
            "fax_number": "518-382-4570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLEN",
        "first_name": "ROBERT",
        "middle_name": "WILLSON",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "007574",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "7574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01698773",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.crednentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1270 Belmont Ave",
            "city": "Schenectady",
            "state": "NY",
            "country_code": "US",
            "postal_code": "123082104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracy Gilbert
• Nisha Dilip-Sarvjit Gill-Jones
• Mahima Gill, DO
• Marjorie Gill, LMHC
• Sarah Anne Gill, PH.D.
• Geoffry Michael Gillespie, MD
• Andrea Gillis, M.D.
• Delaney Shea Gillis, OTR/L
• Caitlin Gillman, CASAC
• David John Gillman, PHYSICIAN ASSISTANT

• Clinical Neuropsychologist in Albany, NY
• Providers in Albany, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.