Provider Demographics
NPI:1003015132
Name:GILL, RETHEL E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RETHEL
Middle Name:E
Last Name:GILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 OTOOLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2238
Mailing Address - Country:US
Mailing Address - Phone:707-712-8536
Mailing Address - Fax:
Practice Address - Street 1:1927 OTOOLE WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2238
Practice Address - Country:US
Practice Address - Phone:707-861-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical