Provider Demographics
NPI:1851025365
Name:GILDERSLEEVE, MARY SINGER (MS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SINGER
Last Name:GILDERSLEEVE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:GILDERSLEEVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 3764
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1764
Mailing Address - Country:US
Mailing Address - Phone:602-577-1079
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3756
Practice Address - Country:US
Practice Address - Phone:619-678-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health