Provider Demographics
NPI:1790875045
Name:GILBERT, MAHLON B (DMIN)
Entity Type:Individual
Prefix:DR
First Name:MAHLON
Middle Name:B
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 ROUTE 87
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1127
Mailing Address - Country:US
Mailing Address - Phone:860-228-9927
Mailing Address - Fax:
Practice Address - Street 1:264 ROUTE 87
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1127
Practice Address - Country:US
Practice Address - Phone:860-228-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000157101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral