MEDICARE: DIANE K GATES LICSW

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
1	1041C0700X	Clinical Social Worker	0890000989	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	382112	OTHER	VT	MVP
2	030215982	OTHER	VT	MAGELLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00068481	OTHER	VT	BCBS

General Provider Information

NPI Number	:	1619978046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE K GATES LICSW

Provider Business Mailing Address
First Line	:	889 DEWING RD
Second Line	:
City	:	FRANKLIN
State	:	VT
Zip	:	05457-9434
Country	:	US
Telephone Number	:	802-285-6511
Fax Number	:	802-285-6508

Provider Business Practice Location Address
First Line	:	889 DEWING RD
Second Line	:
City	:	FRANKLIN
State	:	VT
Zip	:	05457-9434
Country	:	US
Telephone Number	:	802-285-6511
Fax Number	:	802-285-6508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/04/2011

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Directions to “ DIANE K GATES LICSW” Practice Location

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