Provider Demographics
NPI:1245224419
Name:GILBERTSON, THOMAS M (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:GILBERTSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 PARK WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4202
Mailing Address - Country:US
Mailing Address - Phone:865-690-8190
Mailing Address - Fax:865-531-3536
Practice Address - Street 1:9401 PARK WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4202
Practice Address - Country:US
Practice Address - Phone:865-690-8190
Practice Address - Fax:865-531-3536
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0005241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3690339Medicare ID - Type Unspecified