Provider Demographics
NPI:1588653067
Name:GILDERSLEEVE, ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:GILDERSLEEVE
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 1:1980 MOUNTAIN BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2833
Mailing Address - Country:US
Mailing Address - Phone:510-339-2333
Mailing Address - Fax:510-654-9319
Practice Address - Street 1:1980 MOUNTAIN BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2833
Practice Address - Country:US
Practice Address - Phone:510-339-2333
Practice Address - Fax:510-654-9319
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPS7989103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL79890Medicare ID - Type Unspecified