Provider Demographics
NPI:1184242299
Name:GILMAN, ANDREA (LCSW 42922)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GILMAN
Suffix:
Gender:F
Credentials:LCSW 42922
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 N MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-6931
Mailing Address - Country:US
Mailing Address - Phone:208-391-0904
Mailing Address - Fax:
Practice Address - Street 1:1985 N MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-6931
Practice Address - Country:US
Practice Address - Phone:208-391-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID28213104100000X
IDLCSW-429221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker