Provider Demographics
NPI:1144893108
Name:GILBERT, JENNA B (MED, LPC, CAADC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:B
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MED, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTGATE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1392
Mailing Address - Country:US
Mailing Address - Phone:724-684-6489
Mailing Address - Fax:
Practice Address - Street 1:2 EASTGATE AVE STE 102
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1392
Practice Address - Country:US
Practice Address - Phone:724-684-6489
Practice Address - Fax:724-684-7116
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional