Active NPI
Karen Lee Gillock, PHD
- Psychologist
- Lebanon, NH
National Provider Identifier
1518035005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 943
- Practice address
- 115 Etna Rd
Building 1, Suite 2
Lebanon, NH 03766-1429 - Phone
- (603) 448-3588
- Fax
- (603) 448-3583
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 943 | NH | Primary |
Addresses
Primary practice location
115 Etna Rd
Building 1, Suite 2
Lebanon, NH 03766-1429
Mailing address
PO Box 769
White River Junction, VT 05001-0769
Phone (603) 448-3588
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1008149 | Other | VT | MEDICAID |
| 30421560 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 943 | NH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238457600000",
"number": "1518035005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 769",
"city": "WHITE RIVER JUNCTION",
"state": "VT",
"postal_code": "050010769",
"telephone_number": "603-448-3588",
"fax_number": "603-448-3583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 ETNA RD",
"address_2": "BUILDING 1, SUITE 2",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661429",
"telephone_number": "603-448-3588",
"fax_number": "603-448-3583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLOCK",
"first_name": "KAREN",
"middle_name": "LEE",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2009-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NH",
"license": "943",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "1008149",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30421560",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.