Provider Demographics
NPI:1346347036
Name:ENGEL, GILBERT CORBIN (MSW LCSW ACSW)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:CORBIN
Last Name:ENGEL
Suffix:
Gender:M
Credentials:MSW LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1010
Mailing Address - Country:US
Mailing Address - Phone:715-251-3300
Mailing Address - Fax:
Practice Address - Street 1:1249 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1010
Practice Address - Country:US
Practice Address - Phone:715-251-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2902-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3965900Medicaid
WI2902123OtherLCSW
R693601Medicare UPIN