Provider Demographics
NPI:1578621447
Name:GILL, JOSEPH L (MFT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:GILL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CAMELLIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2301
Mailing Address - Country:US
Mailing Address - Phone:408-984-7779
Mailing Address - Fax:
Practice Address - Street 1:920 SARATOGA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3403
Practice Address - Country:US
Practice Address - Phone:408-246-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAML007506170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS