Provider Demographics
NPI:1013242445
Name:GILLMAN, BARRIE L (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BARRIE
Middle Name:L
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:BARRIE
Other - Middle Name:L
Other - Last Name:DEMARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 CABOT ST STE 260R
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4523
Mailing Address - Country:US
Mailing Address - Phone:617-549-6280
Mailing Address - Fax:781-202-9244
Practice Address - Street 1:260 CABOT ST STE 260R
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4523
Practice Address - Country:US
Practice Address - Phone:617-549-6280
Practice Address - Fax:781-202-9244
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10271071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1100914116AMedicaid