Basic Information
| Provider Information | |||||||||
| NPI: | 1790820033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERBER | ||||||||
| FirstName: | VIRGIL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375486842 | ||||||||
| FaxNumber: | 9375488938 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453733047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373357166 | ||||||||
| FaxNumber: | 9373397816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 04/30/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/13/2007 | ||||||||
| NPIReactivationDate: | 05/09/2007 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I184 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1790820033 | 01 | OH | NPI # | OTHER | H248160 | 01 | OH | MEDICARE ID # | OTHER |