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NPI Code Detail

MEDICARE: SAMUEL GILBERT LMSW

MEDICARE: SAMUEL GILBERT LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLMSW--42320ID
2104100000XSocial WorkerLMSW-42320ID

General Provider Information

NPI Number : 1164158770
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL GILBERT LMSW
Provider Business Mailing Address
First Line : 6003 W OVERLAND RD STE 105
Second Line :
City : BOISE
State : ID
Zip : 83709-3075
Country : US
Telephone Number : 208-417-8428
Fax Number : 208-216-1434
Provider Business Practice Location Address
First Line : 6003 W OVERLAND RD STE 105
Second Line :
City : BOISE
State : ID
Zip : 83709-3075
Country : US
Telephone Number : 208-417-8428
Fax Number : 208-216-1434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2022
Last Update Date : 06/10/2026

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Directions to “ SAMUEL GILBERT LMSW” Practice Location

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