Provider Demographics
NPI:1740446731
Name:TILTON, GAYLE DIANE (CSW-R)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:DIANE
Last Name:TILTON
Suffix:
Gender:F
Credentials:CSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 88TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3425
Mailing Address - Country:US
Mailing Address - Phone:716-283-5251
Mailing Address - Fax:
Practice Address - Street 1:712 88TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3425
Practice Address - Country:US
Practice Address - Phone:716-283-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0392081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical