Provider Demographics
NPI:1619095858
Name:GILBERT, KIM LISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LISA
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 SAW MILL BROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3614
Mailing Address - Country:US
Mailing Address - Phone:617-244-6849
Mailing Address - Fax:617-795-1892
Practice Address - Street 1:53 LANGLEY RD
Practice Address - Street 2:SUITE 380
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1913
Practice Address - Country:US
Practice Address - Phone:617-964-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3674103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA771363OtherTUFTS HEALTH PLAN
MA052672000OtherMAGELLAN BEHAVIORAL
MA0515558Medicaid
MAGIW03729OtherBLUE CROSS BLUE SHIELD
MA771363OtherTUFTS HEALTH PLAN