Provider Demographics
NPI:1891831178
Name:GILMAN, WILLIAM PETER (LCSW R)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:GILMAN
Suffix:
Gender:M
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 HARDSCRABBLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13406
Mailing Address - Country:US
Mailing Address - Phone:315-891-3798
Mailing Address - Fax:
Practice Address - Street 1:1174 HARDSCRABBLE ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13406
Practice Address - Country:US
Practice Address - Phone:315-891-3798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0621611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37301Medicare UPIN
CC7465Medicare ID - Type Unspecified