Provider Demographics
NPI:1548352719
Name:SEE-GILMORE, JUDITH A
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:A
Last Name:SEE-GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:SEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1765
Mailing Address - Country:US
Mailing Address - Phone:304-257-1155
Mailing Address - Fax:304-257-1945
Practice Address - Street 1:6 PARK ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1765
Practice Address - Country:US
Practice Address - Phone:304-257-1155
Practice Address - Fax:304-257-1945
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00450797104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker