Provider Demographics
NPI:1659388742
Name:KILGORE, MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 EAST MAIN ST.
Mailing Address - Street 2:#3
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3140
Mailing Address - Country:US
Mailing Address - Phone:203-415-1571
Mailing Address - Fax:203-483-0189
Practice Address - Street 1:230 EAST MAIN ST
Practice Address - Street 2:#3
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3140
Practice Address - Country:US
Practice Address - Phone:203-415-1571
Practice Address - Fax:203-483-0189
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11243002OtherC.A.Q.H.
CT140005030CT02OtherANTHEM ID
CT800002735Medicare ID - Type UnspecifiedINDIVIDUAL