Basic Information
| Provider Information | |||||||||
| NPI: | 1205319837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBURNE | ||||||||
| FirstName: | LAURIE | ||||||||
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| Credential: | LCISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 STANDISH ST | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020502627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812965392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 SANDWICH ST | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023602183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087462000 | ||||||||
| FaxNumber: | 5088302106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 120580 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.