=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396908927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY E GILMAN LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 08/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1061 PLEASANT ST
-----------------------------------------------------
City | NEW BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02740-6728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-996-8572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 OLD WESTPORT RD
-----------------------------------------------------
City | DARTMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02747-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-951-6228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1024932
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------