Provider Demographics
NPI:1679846646
Name:GILBORN, LAELIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:LAELIA
Middle Name:
Last Name:GILBORN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 INDEPENDENCE AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1443
Mailing Address - Country:US
Mailing Address - Phone:301-922-6760
Mailing Address - Fax:
Practice Address - Street 1:1117 INDEPENDENCE AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1443
Practice Address - Country:US
Practice Address - Phone:202-544-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker