Provider Demographics
NPI:1073633012
Name:GILBERT, PATRICIA FIDLER (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FIDLER
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20770 US HIGHWAY 281 N
Mailing Address - Street 2:SUITE 108-151
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7519
Mailing Address - Country:US
Mailing Address - Phone:210-410-5346
Mailing Address - Fax:
Practice Address - Street 1:5364 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6107
Practice Address - Country:US
Practice Address - Phone:210-410-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25602103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0075BGMedicare ID - Type Unspecified