Provider Demographics
NPI:1295832491
Name:GILMAN, JENNIFER LYNNE (MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:GILMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GILMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:80 EUREKA SQUARE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2603
Mailing Address - Country:US
Mailing Address - Phone:650-557-0304
Mailing Address - Fax:650-557-0344
Practice Address - Street 1:80 EUREKA SQUARE
Practice Address - Street 2:SUITE 147
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2603
Practice Address - Country:US
Practice Address - Phone:650-557-0304
Practice Address - Fax:650-557-0344
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist