Healthcare Provider Details

I. General information

NPI: 1619978046
Provider Name (Legal Business Name): DIANE K GATES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANE K WHITEHEAD

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 DEWING RD
FRANKLIN VT
05457-9434
US

IV. Provider business mailing address

889 DEWING RD
FRANKLIN VT
05457-9434
US

V. Phone/Fax

Practice location:
  • Phone: 802-285-6511
  • Fax: 802-285-6508
Mailing address:
  • Phone: 802-285-6511
  • Fax: 802-285-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890000989
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: