Provider Demographics
NPI:1922210277
Name:MCGILVERY, SHARON T (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:T
Last Name:MCGILVERY
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 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:SUITE 238
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6200
Mailing Address - Country:US
Mailing Address - Phone:951-676-3455
Mailing Address - Fax:951-308-1515
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 238
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6200
Practice Address - Country:US
Practice Address - Phone:951-676-3455
Practice Address - Fax:951-308-1515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL151700Medicare ID - Type Unspecified