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General NPI Number Information
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NPI Number | 1760575799
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Entity Type | Individual
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Provider Name | CORINA MARIA GILLETT LICENSED CLINICAL SO
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 4875 BROADWAY STE 125
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City | SACRAMENTO
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State | CA
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Zip | 95820-1500
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Country | US
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Telephone | 916-874-3661
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Fax | 916-875-1190
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Provider Business Mailing Address
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Address Line | 775 FLEISCHMANN WAY BHS OUTPATIENT
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City | CARSON CITY
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State | NV
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Zip | 89703
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Country | US
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Telephone | 775-445-7756
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Fax | 775-841-0304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW 13741
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW24446
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7809-C
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License Number State | NV
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