Provider Demographics
NPI:1821302191
Name:FILLMAN, JOY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ANN
Last Name:FILLMAN
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 1:250 BEL MARIN KEYS BLVD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5707
Mailing Address - Country:US
Mailing Address - Phone:415-609-4041
Mailing Address - Fax:415-408-3400
Practice Address - Street 1:250 BEL MARIN KEYS BLVD
Practice Address - Street 2:SUITE B3
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5707
Practice Address - Country:US
Practice Address - Phone:415-609-4041
Practice Address - Fax:415-408-3400
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical