Healthcare Provider Details

I. General information

NPI: 1346347036
Provider Name (Legal Business Name): GILBERT CORBIN ENGEL MSW LCSW ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 GARFIELD ST
NIAGARA WI
54151-1010
US

IV. Provider business mailing address

1249 GARFIELD ST
NIAGARA WI
54151-1010
US

V. Phone/Fax

Practice location:
  • Phone: 715-251-3300
  • Fax:
Mailing address:
  • Phone: 715-251-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2902-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: