Provider Demographics
NPI:1427138072
Name:GILBERT, TERESA S (LCSW-C)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:S
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5409
Mailing Address - Country:US
Mailing Address - Phone:301-145-1900
Mailing Address - Fax:
Practice Address - Street 1:113 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5409
Practice Address - Country:US
Practice Address - Phone:301-145-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD086271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335981OtherMDIPA/ALLIANCE/OPT.CHOICE
MDBC/BSOtherQB16
MD53540502OtherMD REGIONAL PROVIDER NUMB
MDBC/BSOtherQB16
MDS05681Medicare UPIN