Provider Demographics
NPI:1063910537
Name:GILBERT, STEPHEN POTTER (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:POTTER
Last Name:GILBERT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 TACONIC RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3115
Mailing Address - Country:US
Mailing Address - Phone:203-340-9816
Mailing Address - Fax:
Practice Address - Street 1:237 TACONIC RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-3115
Practice Address - Country:US
Practice Address - Phone:203-340-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist