Provider Demographics
NPI:1679903025
Name:GILBERT, BRENDA C (LCPC-C, CADC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LCPC-C, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MOOR ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-692-4710
Mailing Address - Fax:
Practice Address - Street 1:32 COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-509-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5090101YA0400X
MEXL4579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)