MEDICARE: ELIZABETH HAMMOND PROCTOR GILBERT LCSW

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
2	1041C0700X	Clinical Social Worker	0904011432	VA

General Provider Information

NPI Number	:	1770231623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HAMMOND PROCTOR GILBERT LCSW

Provider Business Mailing Address
First Line	:	318 HARPERSVILLE RD
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-2304
Country	:	US
Telephone Number	:	757-951-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ENTERPRISE DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-3190
Country	:	US
Telephone Number	:	757-736-3725
Fax Number	:

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

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/28/2022

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