Provider Demographics
NPI:1194873372
Name:KILGUS, BARBARA ANN (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:KILGUS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5031
Mailing Address - Country:US
Mailing Address - Phone:516-398-5035
Mailing Address - Fax:516-804-0989
Practice Address - Street 1:627 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5031
Practice Address - Country:US
Practice Address - Phone:516-398-5035
Practice Address - Fax:516-804-0989
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021121-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7478949002OtherGHI PROVIDER
NY462980OtherVALUE OPTIONS