Provider Demographics
NPI:1598287872
Name:GILBERT, ROSEMARIE IX
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:
Last Name:GILBERT
Suffix:IX
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 CHICAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1741
Mailing Address - Country:US
Mailing Address - Phone:313-790-3126
Mailing Address - Fax:
Practice Address - Street 1:19321 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2004
Practice Address - Country:US
Practice Address - Phone:313-586-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-08
Last Update Date:2017-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI727960Medicaid