Provider Demographics
NPI:1649330564
Name:GILMOUR, MARILYN BRINE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:BRINE
Last Name:GILMOUR
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1717
Mailing Address - Country:US
Mailing Address - Phone:508-893-0914
Mailing Address - Fax:508-429-9657
Practice Address - Street 1:200 WINTER ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1717
Practice Address - Country:US
Practice Address - Phone:508-893-0914
Practice Address - Fax:508-429-9657
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000P02068OtherPROVIDER NUMBER BCBS - MA