Provider Demographics
NPI:1003825787
Name:GILBERT, NADINE MAY (LCSW)
Entity type:Individual
Prefix:MISS
First Name:NADINE
Middle Name:MAY
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1414
Mailing Address - Country:US
Mailing Address - Phone:262-781-4434
Mailing Address - Fax:
Practice Address - Street 1:763 MILFORD ST
Practice Address - Street 2:FRONTIER MENTAL HEALTH CLINIC
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6021
Practice Address - Country:US
Practice Address - Phone:920-206-6115
Practice Address - Fax:920-206-6106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7831231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40988800Medicaid
WI40988800Medicaid