Provider Demographics
NPI:1700236122
Name:GILBERT, CHERYLL BAUTISTA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYLL
Middle Name:BAUTISTA
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30724 BENTON RD STE C302 #1015
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596
Mailing Address - Country:US
Mailing Address - Phone:951-290-3910
Mailing Address - Fax:951-468-0609
Practice Address - Street 1:30724 BENTON RD STE C302 #1015
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596
Practice Address - Country:US
Practice Address - Phone:951-290-3910
Practice Address - Fax:951-468-0609
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886831041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health