Provider Demographics
NPI:1477689453
Name:GILBERT, DANA L (MSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:L
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1123
Mailing Address - Country:US
Mailing Address - Phone:617-965-1045
Mailing Address - Fax:617-558-1922
Practice Address - Street 1:110 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1123
Practice Address - Country:US
Practice Address - Phone:617-965-1045
Practice Address - Fax:617-558-1922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1042171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02578Medicare UPIN