Provider Demographics
NPI:1518373109
Name:GILBERT, BIANCA (LLBSW)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1801
Mailing Address - Country:US
Mailing Address - Phone:734-455-0510
Mailing Address - Fax:
Practice Address - Street 1:105 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1801
Practice Address - Country:US
Practice Address - Phone:734-455-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXYH913321551Medicaid