Provider Demographics
NPI:1811033855
Name:GILMORE, SHARON LOUISE
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:LOUISE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAYHEW WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4328
Mailing Address - Country:US
Mailing Address - Phone:925-932-0150
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4328
Practice Address - Country:US
Practice Address - Phone:925-932-0150
Practice Address - Fax:925-210-0842
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA45347IMF106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist