Provider Demographics
NPI:1912270752
Name:GILPATRICK, REBECCA KERRY (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KERRY
Last Name:GILPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LAKE LORRAINE CIR
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1617
Mailing Address - Country:US
Mailing Address - Phone:850-609-0899
Mailing Address - Fax:
Practice Address - Street 1:99 LAKE LORRAINE CIR
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1617
Practice Address - Country:US
Practice Address - Phone:850-609-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 50861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical