Provider Demographics
NPI:1881168870
Name:GILBERT, TRACY A (CSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:GILBERT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 QUEEN ST
Mailing Address - Street 2:STE 301
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1801
Mailing Address - Country:US
Mailing Address - Phone:203-288-0414
Mailing Address - Fax:
Practice Address - Street 1:60 WASHINGTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3257
Practice Address - Country:US
Practice Address - Phone:203-288-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical