Provider Demographics
NPI:1457483646
Name:GILMORE, JEFFREY RYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RYAN
Last Name:GILMORE
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 1:31413 WINTERPLACE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1877
Mailing Address - Country:US
Mailing Address - Phone:410-742-3055
Mailing Address - Fax:443-944-0095
Practice Address - Street 1:31413 WINTERPLACE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1877
Practice Address - Country:US
Practice Address - Phone:410-742-3055
Practice Address - Fax:443-944-0095
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200901041C0700X
MDDO2126133V00000X
MDN00206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered