Healthcare Provider Details

I. General information

NPI: 1205095510
Provider Name (Legal Business Name): ANGELA L GILBERT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MDG UNIT 2060
APO AP
96278-2060
US

IV. Provider business mailing address

PSC 3 BOX 4295
APO AP
96266-0043
US

V. Phone/Fax

Practice location:
  • Phone: 315-784-2148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number03-6E
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1802
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: