Provider Demographics
NPI:1285732529
Name:GILMAN, MICHAEL LEE (LICSW, ACSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:GILMAN
Suffix:
Gender:M
Credentials:LICSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 NORTHSHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-1250
Mailing Address - Country:US
Mailing Address - Phone:802-651-7681
Mailing Address - Fax:
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:SUITE 4G
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4299
Practice Address - Country:US
Practice Address - Phone:802-651-7681
Practice Address - Fax:802-658-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00006421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006827Medicaid
VT610054OtherMVP
VT48460OtherBLUE CROSS BLUE SHIELD
VTVN2356Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER