Provider Demographics
NPI:1164558391
Name:VANIMAN, GAYLE LEE (MFT)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:LEE
Last Name:VANIMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:LEE
Other - Last Name:CURP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 THE ALEMEDA
Mailing Address - Street 2:ALLIANCE FOR COMMUNITY CARE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1136
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-254-9960
Practice Address - Street 1:438 N WHITE RD
Practice Address - Street 2:ALLIANCE FOR COMMUNITY CARE SERVICE TEAM ADULT OUTPATIE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1439
Practice Address - Country:US
Practice Address - Phone:408-254-6828
Practice Address - Fax:408-254-6838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3354Medicare UPIN