Provider Demographics
NPI:1497476253
Name:CARRILLO, GABELIO (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GABELIO
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-2507
Mailing Address - Country:US
Mailing Address - Phone:208-891-8451
Mailing Address - Fax:
Practice Address - Street 1:4300 E FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3138
Practice Address - Country:US
Practice Address - Phone:208-205-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-38728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker