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Individual
DIANE K GATES
Active
Individual
DIANE K GATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000989
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068481
BCBS
VT
01
—
030215982
MAGELLAN
VT
05
—
1011242
—
VT
01
—
382112
MVP
VT
Enumeration date
08/09/2005
Last updated
02/04/2011
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