Healthcare Provider Details

I. General information

NPI: 1790820033
Provider Name (Legal Business Name): VIRGIL GERBER LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date: 03/13/2007
Reactivation Date: 05/09/2007

III. Provider practice location address

550 SUMMIT AVE
TROY OH
45373-3047
US

IV. Provider business mailing address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

V. Phone/Fax

Practice location:
  • Phone: 937-335-7166
  • Fax: 937-339-7816
Mailing address:
  • Phone: 937-548-6842
  • Fax: 937-548-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: