MEDICARE: MARGARET KILGORE L.C.S.W.

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	005030	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11243002	OTHER	CT	C.A.Q.H.
2	140005030CT02	OTHER	CT	ANTHEM ID

General Provider Information

NPI Number	:	1659388742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET KILGORE L.C.S.W.

Provider Business Mailing Address
First Line	:	230 EAST MAIN ST.
Second Line	:	#3
City	:	BRANFORD
State	:	CT
Zip	:	06405-3140
Country	:	US
Telephone Number	:	203-415-1571
Fax Number	:	203-483-0189

Provider Business Practice Location Address
First Line	:	230 EAST MAIN ST
Second Line	:	#3
City	:	BRANFORD
State	:	CT
Zip	:	06405-3140
Country	:	US
Telephone Number	:	203-415-1571
Fax Number	:	203-483-0189

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/19/2009

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