Provider Demographics
NPI:1417965716
Name:GILBERT, ELENOR J (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:ELENOR
Middle Name:J
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S BEMISTON AVE
Mailing Address - Street 2:SUITE 1213
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1907
Mailing Address - Country:US
Mailing Address - Phone:314-862-1873
Mailing Address - Fax:314-862-7353
Practice Address - Street 1:230 S BEMISTON AVE
Practice Address - Street 2:SUITE 1213
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-862-1873
Practice Address - Fax:314-862-7353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0045231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO758207104Medicaid
MO157918OtherBCBS-MO PROVIDER ID NUMBE
MO758207104Medicaid