Provider Demographics
NPI:1972648590
Name:SKIDMORE, GILBERT L (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:L
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2131
Mailing Address - Country:US
Mailing Address - Phone:508-791-1922
Mailing Address - Fax:508-791-1922
Practice Address - Street 1:320 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2131
Practice Address - Country:US
Practice Address - Phone:508-791-1922
Practice Address - Fax:508-791-1922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health