1194914630 NPI number — LINDA J GIL LCDP, LMHC

Table of content: LINDA J GIL LCDP, LMHC (NPI 1194914630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194914630 NPI number — LINDA J GIL LCDP, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIL
Provider First Name:
LINDA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDP, LMHC
Provider Gender Code:
F

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:
1194914630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 KILLEY AVE
Provider Second Line Business Mailing Address:
#12
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-585-0023
Provider Business Mailing Address Fax Number:
401-275-2125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-585-0023
Provider Business Practice Location Address Fax Number:
401-275-2127
Provider Enumeration Date:
10/22/2007

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: 101YA0400X , with the licence number:  LCDP00054 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MHC00419 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62-99030 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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