Provider Demographics
NPI:1992314629
Name:GILBERT, ATANA (LSW)
Entity type:Individual
Prefix:MRS
First Name:ATANA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 ROSITA OAK DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5786
Mailing Address - Country:US
Mailing Address - Phone:931-980-9233
Mailing Address - Fax:
Practice Address - Street 1:21724 LORAIN RD STE 8
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3334
Practice Address - Country:US
Practice Address - Phone:216-202-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker