Provider Demographics
NPI:1528225323
Name:GILBERT, MARY CARLEAN (DSW MSW)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CARLEAN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:DSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CHURCH ST
Mailing Address - Street 2:#802
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-425-1563
Mailing Address - Fax:312-915-7645
Practice Address - Street 1:1609 SHERMAN AVE
Practice Address - Street 2:#319
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-425-1562
Practice Address - Fax:312-915-7645
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490100371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
18284OtherCERTIFIED GROUP PSYCHOTHERAPIST CERTIFICATE NUMBER