Provider Demographics
NPI:1962517938
Name:GILLETTE, PAUL F (LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:GILLETTE
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 1:610 E SOUTHPORT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8590
Mailing Address - Country:US
Mailing Address - Phone:317-783-8383
Mailing Address - Fax:317-782-6929
Practice Address - Street 1:610 E.SOUTHPORT RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8592
Practice Address - Country:US
Practice Address - Phone:317-783-8383
Practice Address - Fax:317-782-6929
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001884A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11541288OtherCAQH