Provider Demographics
NPI:1972643674
Name:GILL, JEFFREY D (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:GILL
Suffix:
Gender:M
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:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34760-1225
Mailing Address - Country:US
Mailing Address - Phone:407-877-8074
Mailing Address - Fax:407-877-0410
Practice Address - Street 1:301 N TUBB ST
Practice Address - Street 2:BOX 1225
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760-8931
Practice Address - Country:US
Practice Address - Phone:407-877-8074
Practice Address - Fax:407-877-0410
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0003983103T00000X
FLSW39831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z8176AMedicare ID - Type Unspecified