Provider Demographics
NPI:1265421853
Name:GILMORE, CATHI SONNEBORN (LICSW (MSSA))
Entity type:Individual
Prefix:MS
First Name:CATHI
Middle Name:SONNEBORN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LICSW (MSSA)
Other - Prefix:MS
Other - First Name:CATHI
Other - Middle Name:LESLIE
Other - Last Name:SONNEBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA LICSW
Mailing Address - Street 1:144 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2005
Mailing Address - Country:US
Mailing Address - Phone:617-969-6093
Mailing Address - Fax:
Practice Address - Street 1:23 PLEASANT ST
Practice Address - Street 2:STE 2
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1836
Practice Address - Country:US
Practice Address - Phone:617-969-6093
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1008581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03477OtherBLUE CROSS BLUE SHIELD
T167169OtherAETNA
P20724Medicare ID - Type Unspecified