Provider Demographics
NPI:1336280791
Name:GILL, ALICE ANN (LMT LCSW OTRL)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANN
Last Name:GILL
Suffix:
Gender:F
Credentials:LMT LCSW OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 NW 32ND PLACE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-378-9723
Mailing Address - Fax:
Practice Address - Street 1:1204 NW 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-378-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6332104100000X
FLMA5133225700000X
FLOT107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z013COtherUPIN SOCIAL WORK LCSW
C5737Medicare UPIN
E6507Medicare ID - Type UnspecifiedSOCIAL WORK COVERED MEDIC