Provider Demographics
NPI:1841324589
Name:GILLIAND, WILLIAM JOHN (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:GILLIAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RENGERMAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06027-1606
Mailing Address - Country:US
Mailing Address - Phone:860-653-3932
Mailing Address - Fax:
Practice Address - Street 1:28 RENGERMAN HILL RD
Practice Address - Street 2:
Practice Address - City:EAST HARTLAND
Practice Address - State:CT
Practice Address - Zip Code:06027-1606
Practice Address - Country:US
Practice Address - Phone:860-653-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056751041C0700X
MA1117831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23383Medicare ID - Type UnspecifiedPART B CARRIER