Basic Information
| Provider Information | |||||||||
| NPI: | 1124474622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | LOTTIE | ||||||||
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| Credential: | LMSW-CC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 358 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049370358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074534708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1604 BENTON AVE | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049013327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074534708 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2016 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LM13753 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.