Provider Demographics
NPI:1326110487
Name:GILL, COLE M (MSW)
Entity Type:Individual
Prefix:MR
First Name:COLE
Middle Name:M
Last Name:GILL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FRIEND STREET
Mailing Address - Street 2:ELEMENT CARE INC
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:781-715-6608
Mailing Address - Fax:781-715-6699
Practice Address - Street 1:37 FRIEND ST
Practice Address - Street 2:ELEMENT CARE INC
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902
Practice Address - Country:US
Practice Address - Phone:781-581-7565
Practice Address - Fax:617-474-0757
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA214261OtherSTATE LICENSE #