1962517938 NPI number — PAUL F GILLETTE LCSW

Table of content: PAUL F GILLETTE LCSW (NPI 1962517938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962517938 NPI number — PAUL F GILLETTE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLETTE
Provider First Name:
PAUL
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962517938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 E SOUTHPORT RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46227-8590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-783-8383
Provider Business Mailing Address Fax Number:
317-782-6929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 E.SOUTHPORT RD.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46227-8592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-783-8383
Provider Business Practice Location Address Fax Number:
317-782-6929
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34001884A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11541288 . This is a "CAQH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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