Provider Demographics
NPI:1417052796
Name:GILBERT, NEIL LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:LEE
Last Name:GILBERT
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 1:914 LINCOLN WAY W
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-1152
Mailing Address - Country:US
Mailing Address - Phone:574-287-0391
Mailing Address - Fax:574-235-7259
Practice Address - Street 1:914 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46616-1152
Practice Address - Country:US
Practice Address - Phone:574-287-0391
Practice Address - Fax:574-235-7259
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002531A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217590CMedicare ID - Type UnspecifiedMEDICARE
INR33382Medicare UPIN