Provider Demographics
NPI:1205258738
Name:GILBERT, TINA RENEE (LICSW)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:RENEE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:MAIL STOP: S-128-SCI
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-6843
Mailing Address - Fax:206-764-2542
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:MAIL STOP: S-128-SCI
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-6843
Practice Address - Fax:206-764-2542
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWI.LW.603089021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical