Provider Demographics
NPI:1588770945
Name:GILBERT, KATHY J (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 CAMINO DEL RIO S
Mailing Address - Street 2:STE 122
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3910
Mailing Address - Country:US
Mailing Address - Phone:619-574-0677
Mailing Address - Fax:858-695-9823
Practice Address - Street 1:3435 CAMINO DEL RIO S
Practice Address - Street 2:STE 122
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3910
Practice Address - Country:US
Practice Address - Phone:619-574-0677
Practice Address - Fax:858-695-9823
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12657104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW12657AMedicare ID - Type Unspecified